When adjusted for age and gender, the mean difference was greater . Additionally, there was a significant reduction in blood urea nitrogen and serum creatinine . Moreover, the intervention had a positive impact on weight loss and body mass index  and lipid profile, with a significant reduction in total cholesterol and triglyceride levels . Additional significant results from the NIG included reduced uric acid , serum phosphorus , fasting blood glucose  and glycated hemoglobin . Conclusions: This study suggests that, in patients of CKD, nutritional intervention counselling plays a significant role in reducing the time needed for dialysis and improves nutritional-related biomarkers compared to patients not receiving this intervention.Background: Chronic kidney disease (CKD) is a global health issue. Evidence of the effectiveness of nutritional intervention on slowing time to dialysis is limited in Arab countries. Therefore, this study aims to contribute to current research by providing new insights on the efficacy of personalized nutritional intervention in pre-dialysis patients in the Kingdom of Bahrain. Methods: This retrospective cohort study included 265 CKD patients  who were admitted to the nephrology outpatient clinic at Salmaniya Medical Complex in Bahrain. The nutritional intervention group (NIG) receiving dietary advice by an expert renal dietitian consisted of 121 patients, while the non-nutritional intervention control group (non-NIG) that did not receive any nutritional support consisted of 150 patients. Patients were evaluated at baseline and follow-up. Results: The NIG had a significant increase in the estimated glomerular filtration rate (eGFR) compared to the non-NIG that had a significant decrease (5.16 vs. −2.85 mL/min/1.73 m The global health burden of chronic kidney disease (CKD) is increasing rapidly, affecting 850 million people worldwide and is predicted to become the fifth most common leading cause of death worldwide by 2040 . In the CKD management requires a multidisciplinary approach with involvement of highly specialized team members such as nephrologists, nurses, pharmacists, social workers and dietitians. Additionally, medical costs are much higher with increasing severity of CKD. As such, timely referral of CKD patients to the multidisciplinary renal unit is crucial to delaying kidney disease progression, reducing the initial cost of care even before the commencement of dialysis and decreasing the chance of kidney transplantation, comorbidities, and mortality .In the renal unit, nutritional care is recommended for all stages of CKD since it aims to improve the nutritional status of patients, slowing the progression to dialysis by delivering tailored educational and dietary advice . DespiteIn fact, it has been highlighted that an individualized diet, compared to the control, produces a significantly beneficial effect in terms of quality of life ,5,6, morGiven this background, the aim of this study was to determine whether nutritional therapy has a role in slowing the progression of kidney failure in a cohort of Bahraini outpatients, through the assessment of the eGFR as the main outcome. The secondary objective of this study was assessing the effectiveness of dietary therapy by the evaluation of different biomarkersThis study is a retrospective, single-center cohort study. The protocol was approved by the health/social care community care research in the Ministry of Health (MOH) in Bahrain and the ethics committee of the Department of Biology, University of Bahrain, Bahrain. The university trial registration number is MAD/127/2020. This study was conducted at Salmaniya Medical Complex (SMC) in Manama, Bahrain. All participants gave their informed consent prior to their inclusion in this study in accordance with the Declaration of Helsinki. The inclusion criteria were patients older than 18 years of age with confirmed diagnosis of CKD. Patients who dropped out from the protocol, or with a single or transplanted kidney, or diagnosed with acute kidney injury, kidney stones, liver disease, polycystic kidney disease, nephrotic syndrome or cancer were excluded from this study. After applying the inclusion/exclusion criteria, a total of 265 patients were calculated with 147 patients in the non-nutritional intervention control group (non-NIG) and 118 patients in the nutritional intervention group (NIG) by using t-statistic and non-centrality parameter and taking into consideration a power rate of 80% ,13. The 2; blood urea nitrogen (BUN), mmol/L; creatinine, µ mol/L; urinary albumin/creatinine ratio (UACR), mg/mmol; microalbuminuria, mg/L; calcium, mmol/L; serum phosphorus, mmol/L; potassium, mmol/L; sodium, mmol/L; parathyroid hormone (PTH), pmol/L; uric acid, µmol/L; total cholesterol, mmol/L; low-density lipoprotein (LDL), mmol/L; high-density lipoprotein (HDL), mmol/L; triglyceride, mmol/L; fasting blood glucose (FBG), mmol/L; and glycated hemoglobin (HbA1c), mmol/mol. Baseline time was considered as the date of CKD diagnosis by the nephrologist for the non-NIG subjects and the date of the first visit to the renal dietitian for the NIG patients. The National kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) clinical practice guidelines were applied for patients with an eGFR lower than 30 mL/min/1.73 m2 involving routine monitoring of nutritional status at 1–3 months intervals and a follow-up every 6–12 months for patients with an eGFR of 30–60 mL/min/1.73 m2 [Baseline and follow-up data were obtained from the electronic medical records system of outpatients visiting SMC from 1 January 2016 to 31 December 2019. Patients were allocated into two groups, the NIG and the non-NIG that did not receive any dietary support. Data collected at baseline included age, gender, anthropometric and hematochemical data, drugs used, comorbidities and follow-up period. Laboratory data included values for hemoglobin, g/dL; serum albumin g/L; eGFR, mL/min/1.73 m/1.73 m2 .Individualized nutrition care was provided for patients in the NIG, by a trained renal dietitian, according to their level of kidney function, electrolytes abnormalities, comorbidities and nutrition status. Nutrition care plans focused on providing face-to-face counseling and meeting adequate energy and protein requirements with low sodium and modified potassium and phosphorus intakes according to the Academy of Nutrition and Dietetics’ guidelines for adults with CKD. Specifically, the nutritional recommendations for adults with chronic kidney disease stages 3 to 4 were set for protein ≤0.8 g/kg/day, increase plant source, salt <2.3 g/day (<5 g/day of NaCl), potassium individualize to keep the serum potassium within a normal range, calcium 1.5 g/day from both dietary and medication sources, phosphorus 0.8 to 1 g/day or individualize to keep the value within a normal range, increase vegetable source and avoid processed foods as much as possible. Carbohydrate/fat from 30 to 35 kcal/kg/day; <30% of total calories from fat and <10% of total fat from saturated fat; and fiber from 25 to 38 g/day (KDOQI guidelines) [On the other hand, patients in the non-NIG were not visited by the renal dietitian but were given generic nutritional information containing dietary advice that is typically provided to CKD patients by nephrologists. The participants’ recommendations were followed up by the dietitian monthly through the FFQ. p value < 0.05.All the data were analyzed by using Statistical Package for the Social Sciences (SPSS) package version 23.0, Armonk, NY, USA). Continuous variable analyses were reported as the mean ± standard deviation. The data collected from both groups were compared within and between the groups by using analysis of covariance (ANCOVA). Differences were considered as statistically significant with Of the 1213 patients admitted in the out-patient nephrology clinic during the specified period, 271 patients were identified and included as the study sample. The excluded patients (77.66%) were those who were below 18 years, lacking laboratory data, lost during follow-up, renal transplant recipients, and diagnosed with any of the following: acute kidney injury, kidney stones, liver disease, polycystic kidney disease, nephrotic syndrome, or cancer. The enrolled patients were divided into two groups: the intervention group (NIG), where 121 patients received counselling from a renal dietitian, and the control group (non-NIG), where 150 patients did not receive consultation .Many of the enrolled patients had hypertension (87.8%) and diabetes (79.7%), but lower than one-fifth (19.3%) had had heart disease. In terms of the follow-up period, 83.6% of the patients received a follow-up service within 0–6 months, while only 16.3% received a follow-up after 7–15 months after the baseline evaluation .p = 0.051)  and elderly, with a mean age of 66.5 ± 13.6 years. Nonetheless, the NIG patients were relatively young compared to the non-NIG patients (64.7 years ± 12.0 versus 67.9 years ± 14.6), and this difference was nearly statistically significant (= 0.051) .2 ± 13.213; non-NIG 32.87 mL/min/1.73 m2 ± 16.166; p-value = 0.044), and albumin levels .In terms of baseline characteristics, there were no statistically significant differences between the two groups  with the2 ; p = 0.000, respectively), while in the control, the non-NIG, the change was not significant (Anthropometric data in the NIG showed a significant decrease in body weight and body mass index (BMI) following the intervention  and BMI ∆ = −0.6904 kg/mnificant .2 ; p = 0.000). Conversely, the control, the non-NIG, showed a significant decrease in the eGFR ; p = 0.000). As shown in p = 0.006 and ∆ = −0.15 * mmol/L ; p = 0.026, respectively). However, the decrease in LDL level was not significant. In the non-NIG patients, the levels of total cholesterol, LDL, HDL, and triglycerides remained stable. Furthermore, FBG levels were significantly improved among the NIG patients ; p = 0.016), while the HbA1C values remained unchanged in both groups at follow-up. Similar statistically significant changes in the NIG were found in levels of BUN and creatinine, uric acid and phosphorous, with all showing a decrease from the baseline.Moreover, the change in the eGFR from baseline to follow-up in the NIG significantly increased (∆ = 5.165 * mL/min/1.73 mp = 0.022), BMI , the eGFR , BUN , creatinine , total cholesterol . However, there were no significant differences between the groups following the intervention for albumin, sodium, potassium, calcium, phosphorus, PTH, and hemoglobin  were noted for body weight  .In this study, we present for the first time in the Arab world clear evidence of the superiority of a personalized nutritional intervention, combined with traditional nephrological assistance, in the treatment of CKD in outpatient subjects, thereby creating favorable health outcomes in terms of weight management, metabolic response, and dialysis postponement. The results of this study may assist regional and local authorities and governments in reducing health care costs related to dialysis treatment by paying more attention to preventive dietary measures. The limitations of this study were such that the baseline characteristics of the NIG and the non-NIG were not completely comparable, especially for the primary outcome: the eGFR due to the lack of randomization. However, this bias may be overcome by the extreme difference in terms of the eGFR between groups at the end of the intervention. Nonetheless, we believe that the evidence presented here provides support for additional research that involves two similar cohorts with proper randomization. Close monitoring of body composition with the use of bioimpedance or DXA for assessing body composition, muscle mass, strength, physical function were not provided in this study and should be presented as shortcomings of this study.


Patients with hypertension (N = 36) had a larger RSF depot compared to normotensive subjects  also after accounting for body mass index (BMI). In the pooled data, RSF was negatively associated with eGFR , whereas there was no association with systolic or diastolic blood pressure. Following bariatric surgery, RSF was reduced  along with other markers of adiposity. A total of 9/27 of patients achieved remission from hypertension. The remission was associated with a larger decrease in RSF, compared to patients who remained hypertensive . The accumulation of RSF seems to be involved in the pathogenesis of hypertension in obesity. Following bariatric surgery, loss of RSF was associated with remission from hypertension. Renal sinus fat is a fat depot at the renal hilum. Because of its location around the renal artery, vein, and lymphatic vessels, an expanded renal sinus fat mass may have hemodynamic and renal implications. We studied whether renal sinus fat area (RSF) associates with hypertension and whether following bariatric surgery a decrease in RSF associates with improvement of hypertension. A total of 74 severely obese and 46 lean controls were studied with whole-body magnetic resonance imaging (MRI). A total of 42 obese subjects were re-studied six months after bariatric surgery. RSF was assessed by two independent researchers using sliceOmatic. Glomerular filtration rate (eGFR) was estimated according to the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). Patients with obesity accumulated more RSF compared to lean controls (2.3 [1.7–3.1] vs. 1.8 [1.4–2.5] cm In the last decades, we have been facing a global epidemic of obesity, with the prevalence of the disease having tripled in the last four decades . CurrentArterial hypertension is directly related to obesity in at least 75% cases ; vice veRenal sinus is the perirenal hilum region at the medial border of the kidney where the renal artery, the renal vein, lymphatic vessels, and the ureter enter the kidney. The expansion of the renal sinus fat mass, which is a part of visceral adipose tissue (VAT), has been associated with both higher systolic blood pressure or the higher number of antihypertensive drugs needed ,11, as w2 was not different between the two groups, but when accounting for the individual BSA, total eGFR (mL/min) was higher in patients with obesity. The anthropometric and biochemical characteristics of the study participants are listed in Patients with obesity and healthy lean controls were well-matched in terms of age, but as expected patients affected by obesity had higher adiposity measures comprising of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) fat mass, higher systolic and diastolic blood pressure, worse insulin sensitivity, and higher inflammatory markers. Estimated glomerular filtration rate (eGFR) expressed in ml/min/1.73 mr = 0.53, p < 0.0001) and to a smaller extent with SAT mass , age , and BMI . In line with these findings, patients with obesity had higher RSF compared to lean controls  . RSF was not associated with systolic or diastolic blood pressure. However, on dividing the study population in patients with and without hypertension, RSF was significantly higher in patients with hypertension (p = 0.02). RSF was negatively associated with eGFR   compared to the lean controls . In the = 0.003) A. Men alrtension B, and th = 0.03) C. After bariatric surgery patients achieved significant weight loss  and blood pressure was improved . A total2, for before and after bariatric surgery, respectively, p < 0.0001); as were other fat depots   (RSF was significantly decreased following bariatric surgery (2.3 [1.7–3.1] vs. 1.6 [1.3–2.3] cmt depots . The cha = 0.01) A. Moreov = 0.01) B. 2 or >35 kg/m2 with an additional risk factor, aged 18–60 years, and a history of non-successful carefully planned conservative treatments. Individuals using insulin treatment and/or with mental disorders, eating disorders, excessive use of alcohol, or poor compliance were excluded, as were those with a body weight over 150 kg because of restrictions of the imaging devices. Healthy lean participants were recruited via an advertisement in local newspapers. Thirty-six patients with obesity had arterial hypertension, which is defined as arterial blood pressure greater than 140/90 mmHg, use of antihypertensive medication to lower blood pressure [Data of three clinical studies were analysed, where the main topic was to assess differences in tissue metabolism between obese and lean individuals and the effect of bariatric surgery-induced weight loss on whole-body insulin sensitivity and tissue metabolism ,24,25. Wpressure , or prevpressure . Change Clinical screening and anthropometric and biochemical measurements were performed as previously described . Blood pAbdominal fat volumes were calculated by one user (P.D.) from a whole-body MRI scan  using the SliceOmatic Tomovision software (version 4.3) as previously reported  Figure C.The eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation .BSA was estimated as previously described by Du Bois and Du Bois; a formula using each individual’s body weight and height .OGIS was calculated from the oral glucose tolerance test data, as previously described by Mari et al. .http://webohjekirja.mylabservices.fi/TYKS/, accessed on 5 May 2022). Glycosylated hemoglobin (HbA1c) was measured with ion-exchange high performance liquid chromatography  or a photometric immunoturbidimetric method . Plasma insulin and C-peptide were determined by automatized electro-chemiluminescence analyser immunoassay  . Plasma 2 test. Group comparisons were performed with Student’s t-test for normally distributed or the Wilcoxon rank test for non-normally distributed variables. Associations were tested with a linear logistic regression analysis. Statistical analyses were done using JMP version 13.0 . A p value < 0.05 was considered statistically significant. Plots were created using the packages ggplot2 and psych of the R statistical computing environment version 4.1.1 (10 August 2021), created from the R Core Team  and Rstudio (version 1.4.1717) [Data were presented as mean ± SD . Categorical variables were expressed as percentages. The comparison between categorical variables was performed by the chi.4.1717) ,36. To a.4.1717) . We founThis study yielded several outcomes. First, patients with obesity accumulate more fat in the renal sinus compared to heathy lean individuals. Patients with hypertension also have larger RSF, compared to normotensive subjects. In the pooled data, renal sinus fat correlates inversely with eGFR. Following bariatric surgery, RSF was decreased and patients who achieved hypertension remission had a larger decrease in RSF compared to patients who did not achieve remission. Finally, in patients with no hypertension remission post-bariatric surgery, a larger decrease in RSF was associated with a decrease in the number of antihypertensive drugs used. RSF is a compartment of VAT that is situated in the renal hilum. Along with the well-established expansion of VAT in patients with obesity, RSF is also expanded, with the two measurements being directly and strongly related. VAT accumulation has been shown to be related to worse cardiologic burden . MetabolIn a subset of the Framingham cohort, Foster and colleagues demonstrated that “fatty kidney” (defined as RSF greater than the 90th percentile of a nonobese group) was associated with a higher odds ratio of hypertension and CKD—independently of BMI or VAT —demonstr2. As expected, SAT and VAT depots were also largely decreased. We found that RSF was also significantly decreased. This finding contrasts the results of Krievina et al. who have previously reported that significant reduction in VAT (>5% decrease) is not associated with a significant reduction in renal sinus fat mass [2, and the only intervention was participants receiving daily text messages with practical recommendations on how to balance caloric intake and physical activity to achieve and maintain a healthy body weight. The smaller baseline BMI of the subjects and the smaller weight loss achieved may have hampered the study from detecting a change in RSF mass. Following bariatric surgery, the median decrease in BMI was 10 kg/mfat mass . That stThe most salient finding of the present study was that following bariatric surgery, not only was the amount of RSF decreased, but more importantly, subjects who achieved remission from hypertension after bariatric surgery also had a larger decrease in RSF. In keeping with this result, patients with no hypertension remission who achieved reduction in antihypertensive drugs use had a larger decrease in RSF compared to those who maintained the same drugs following bariatric surgery. Ricci et al. assessed perirenal fat thickness by ultrasound. They reported that following sleeve gastrectomy, patients decreasing the number of antihypertensive drugs had higher perirenal fat thickness at baseline . However2 was an exclusion criterion, so the more expanded RSF in the present study may be attributed to the inclusion of patients with severe obesity. However, RSF in the lean controls was also larger in our study compared to the no fatty kidney group of the study by Foster et al., even though the authors mentioned that RSF ranged from the lower limit of detection (0.0048 cm2) to 4.89 cm2—an upper limit similar to our range (0.62–5.83 cm2). We think that the discrepancy, mainly at the low end values, may be related to technical issues , or even to error. In the present study, we consistently drew the renal sinus fat areas in the same way across all subjects; thus, apart from the absolute values, we think that the main results of the present study are not affected.The strength of the present study is the measurement of RSF both at baseline and after bariatric surgery, using state-of-the art methods, such as MRI. Our study also has some limitations. First, the number of patients studied following bariatric surgery was rather small; future studies are needed to confirm the present findings. Since our dataset consisted predominantly of women the generalizations of the findings to a population consisting of men need to be done with caution. This is of particular importance since men tend to accumulate more fat in the visceral depot, as discussed in , and as In conclusion, the accumulation of fat in the renal sinus is larger in patients with morbid obesity, but it is decreased following bariatric surgery. Importantly, patients with larger decreases in RSF following bariatric surgery achieved remission from hypertension, or a decrease in the number of antihypertensive drugs needed. Taken together, these findings suggest that renal sinus fat accumulation may contribute to the pathophysiology linking obesity to hypertension.


Many potential biomarkers in nephrology have been studied, but few are currently used in clinical practice. One is osteopontin (OPN). We compared urinary OPN concentrations in 80 participants: 67 patients with various biopsy-proven glomerulopathies (GNs)—immunoglobulin A nephropathy , membranous nephropathy  and lupus nephritis  and 13 with no GN. Follow-up included 48 participants. Machine learning was used to correlate OPN with other factors to classify patients by GN type. The resulting algorithm had an accuracy of 87% in differentiating IgAN from other GNs using urinary OPN levels only. A lesser effect for discriminating MN and LN was observed. However, the lower number of patients and the phenotypic heterogeneity of MN and LN might have affected those results. OPN was significantly higher in IgAN at baseline than in other GNs and therefore might be useful for identifying patients with IgAN. That observation did not apply to either patients with IgAN at follow-up or to patients with other GNs. OPN seems to be a valuable biomarker and should be validated in future studies. Machine learning is a powerful tool that, compared with traditional statistical methods, can be also applied to smaller datasets. According to the U.S. Centers for Disease Control and Prevention, the number of people affected with chronic kidney disease (CKD) in the United States has reached 37 million—15% of the adult population ,3, mRNA Osteopontin (OPN) is a multifunctional, extracellular phosphoprotein that is expressed in various cells and tissues, including fibroblasts, osteoblasts, macrophages, endothelial cells, adipocytes, Kupffer cells, and dendritic cells. Studies have demonstrated that OPN plays a role in the development of inflammation, wound healing, cancer metastases, diabetes, nephrolithiasis, and modulation of osteoclast function (reviewed in ).The role of OPN in glomerular diseases is not clearly defined. OPN gene polymorphisms are associated with the development of diabetic nephropathy in type 2 diabetes , urinaryOur aim in the present study was to compare uOPN concentrations in patients with various GNs and to use machine learning (ML) to correlate those concentrations with clinical factors and with PRDXs.n = 29), LN (n = 18), MN (n = 20) and 13 healthy individuals defined by the absence of any kidney disease or other chronic diseases requiring treatment. Measurement from 48 participants were available during follow-up: 43 patients—IgAN (n = 18), LN (n = 11), MN (n = 14) and 5 healthy individuals. IgAN, LN, and MN were confirmed by renal biopsy. The healthy control group consisted of age- and sex-matched volunteers. Exclusion criteria were active infection, current pregnancy, history of malignancy, or prior organ transplantation. Written informed consent was given by all study participants. OPN at baseline was measured in 80 participants: 67 patients—IgAN , body mass index, and 24 h proteinuria.The study was approved by the Ethics Committee of the Medical University of Warsaw, nos.: KB/9/2010 (26 January 2010) and KB/199/2016 (11 October 2016). All study procedures proceeded in accordance with the Helsinki Declaration of 1975, revised in 2000.2) to evaluate body mass index.Urine samples (second or third morning urine) were centrifuged (10 min at 2000 rpm) within 120 min from collection, aliquoted into 2 mL cryovials, and frozen at −80 °C until use. Laboratory tests such as serum creatinine, blood morphology, urinalysis, and urinary protein were performed using routine laboratory techniques. PRDX concentrations had been obtained during a previous study of the same patient sample . The eGFOPN was measured with the Human Osteopontin (OPN) Quantikine ELISA Kit . Urine samples were diluted 20× with assay diluent according to the manufacturer’s instructions. To each well in the 96-well microplate , 100 μL of assay diluent was added; then, 50 μL each of standard and sample were pipetted into the wells in duplicate. The microplate was then incubated for 2 h at room temperature (22–25 °C), allowing the OPN in the sample to be bound by the immobilized antibody. After incubation, any unbound substances were washed away manually using a wash buffer provided by the manufacturer and according to the assay procedure, and 200 μL of an enzyme-linked polyclonal antibody specific for human OPN was added to the wells. The plate was again incubated for 2 h at room temperature (22–25 °C). After a wash to remove any unbound antibody–enzyme reagent, 200 μL of a substrate solution was added to the wells, where color developed in proportion to the amount of OPN bound in the initial step. The color development was stopped by the addition of the stop solution included with the assay, and the optical density was subsequently measured using a BioTek PowerWave XS microplate reader  at a wavelength of 450 nm. To determine the OPN concentration (ng/mL), the GraphPad Prism software application  used the optical density with a standard curve (4-parameter logistic equation), including extrapolation. Each result was multiplied by 20 to obtain the actual urine OPN concentration.U-test. Correlations between pairs of parameters were examined using Spearman’s correlation analysis., The differences between categorical variables were calculated with Chi square test. The level of significance was set to p < 0.05.The statistical analysis was performed in the GraphPad Prism (version 9.0.1) and Statistica  software applications. Results are expressed as mean ± standard deviation, median ± interquartile range, or a percentage. All variables were examined by the Shapiro–Wilk test for normal distribution. Non-normally distributed variables were analyzed using nonparametric tests. Comparisons between demographic variables were tested using the Kruskal–Wallis test and between the control and GN groups, using the Mann–Whitney We performed analysis of the data set using an approach based on the supervised machine learning algorithms. Application of machine learning (ML) allows us to perform rapid exploration of data without prior statements of detailed models and with minimal assumptions about data. ML also automatically includes interactions between variables into account. All findings of the ML approach were verified with the help of statistical analysis, and very good agreement between both methods was obtained, in particular when a strong signal was obtained. We used the ML algorithm Random Forest  to buildThe analysis consisted of two steps. In the first step, the all-relevant-features selection algorithm Boruta  was usedThe Boruta algorithm belongs to the class of all-relevant-features selection algorithms. It is a wrapper around Random Forest. It works by extending the original set of variables by their randomized copies, so-called shadow variables. By design, the randomized copies carry no information about the decision variable. Boruta builds multiple Random Forest classifiers, each using a different set of shadow variables, and compares the importance of the original variables with the importance of the most important shadow variable (shadow max) from each set of shadow variables. The variables whose importance exceeds that of the most important shadow variable in a statistically significant way are deemed relevant. The variables that are statistically less important than the most important shadow variable are deemed irrelevant. The variables for which the test is inconclusive are called tentative. A full description of applied algorithms is available in Due to the randomized character of used algorithms, the results may minimally differ between each calculation.Our results are divided into three sections. First is the analysis performed with ML. An algorithm was introduced to a set of laboratory data and biopsy-proven diagnoses from half the samples, thus “teaching” the algorithm to form diagnostic pathways (decision trees based on yes/no commands). Those decision trees were then applied to a set of data without a known diagnosis to test their accuracy . Second Based on the provided data, the algorithm “decides” which sample matches which GN. However, not every variable has equal significance. We compared the importance of the variables marked as significant by the algorithm in correctly classifying a patient to a GN class . A higheUsing the previously selected variables , we tested our algorithm by finding patients with IgAN from among other non-IgAN samples. In Ten runs of the Random Forest classifier were performed. The results are nonrandom, as shown in In previous research, our team studied PRDXs as potential biomarkers of oxidative stress in IgAN, MN, and LN . We obseOPN was again the key variable for correctly enrolling patients into the IgAN class. Mean eGFR was the most important variable for healthy participants, and WBC and Hb were important for predicting the LN class. However, PRDX3 was now equally as strong as WBC for the LN class, and it also appears to be relevant for the MN class (together with eGFR in the latter case). In contrast to the results presented in As mentioned in The Spearmann correlation analysis summarized in To investigate the potential relationship between the OPN and platelets ,23, we sp value < 0.0001 was considered significant). The Kyoto Encyclopedia of Genes and Genomes was used to select the major biologic pathway–based target gene [p value obtained from each biologic route was adjusted using the Benjamini–Hochberg false discovery rate procedure [We also prepared a functional analysis of selected proteins to evaluate their role in various biologic pathways, with eight proteins being functionally analyzed in gene ontology terms  could be factors responsible for discrepancies in OPN levels at baseline and follow-up . HoweverOPN is involved in many metabolic pathways, as shown in Our study has several limitations. First, each GN was represented by a small sample. As our patient database evolves, those numbers will increase. For now, this research can be considered a preliminary study aimed at creating more interest in the topic. Second, further studies should include more proteins/markers or even the whole serum/urinary proteome. Third, OPN levels are likely to be linked to a histologic process and not to a specific GN. Correlation between OPN and a proteomic tissue analysis would be a valuable contribution and should be included in prospective studies. However, the need for the protocol to obtain control biopsies in patients during remission might be problematic. We did not correlate the OPN levels with kidney biopsy results for a few reasons: (1) each of studied glomerulonephritis has their own and completely different classification; (2) so, from this point of view the group was highly heterogenic, and (3) some biopsies were performed and evaluated in other centers by other pathologists that could influence the results. We summarized the biopsies result in Given a growing burden of CKD, biomarker identification and validation have become an emerging issue. In our opinion, OPN should be included in further studies as a potential biomarker in nephrology. Based on our results, we are sure that ML should become a standard in biomarker research. As a supplement to ML, proteome databases can help place results in the context of numerous biologic pathways, pointing toward proteins that could be the next step in nephrology biomarker research.


Acute kidney injury is a rare complication of pregnancy and is associated with high maternal morbidity and mortality. Obstetric factors associated with it are preeclampsia/eclampsia, sepsis, hemorrhage and dehydration. Here, we aim to find out the prevalence of complete recovery of renal function among obstetric patients with acute kidney injury.This is a descriptive cross-sectional study conducted in a tertiary care hospital from 1st July 2020 to 30th June 2021 where obstetric patients who had developed acute kidney injury were included and followed till 6 weeks of diagnosis. Ethical approval was obtained from Institutional Review Committee of Nobel Medical College and Teaching Hospital (Reference number 437/2020). The convenience sampling method was used. Data entry and analysis were done using Statistical Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.Out of total 66 obstetric patients with acute kidney injury, 45 (68.2%)  had complete recovery of renal function. Rate of renal function recovery in Stage 1, Stage 2 and Stage 3 acute kidney injury were 19 (90%), 19 (86%) and 7 (58%) respectively. The most common causes of acute kidney injury were Preeclampsia/eclampsia 18 (40%), sepsis 23 (28.8%) and hemorrhage 10 (22.2%).The prevalence of complete recovery in obstetric patients with acute kidney injury was similar to findings from other studies done in similar settings. The incidence of acute kidney injury has decreased in recent years due to improved maternal health care.3 The current data do not accurately state the incidence of acute kidney injury because of diverse defining criteria of AKI in pregnancy. The value of serum creatinine is less than normal range in pregnancy and level more than 1.02mg/dl is diagnostic of AKI.4 AKI in pregnancy is associated with septic abortion in early pregnancy and preclampsia/eclampsia and hemorrhage in late pregnancy.1 In the past, AKI was considered to be a reversible pathology, but recent studies have shown otherwise.According to Wiles, et al. AKI complicates 1.4% admission in the United Kindgom (UK) whereas in developing countries, it is 4-15%.The aim of this study is to prevalence of complete recovery of renal function among obstetric patients with acute kidney injury in a tertiary care hospital.This was a descriptive cross-sectional study conducted in Nobel Medical College and Teaching Hospital from 1st July 2020 to 30th June 2021 among obstetric patients who had developed acute kidney injury. Ethical clearance was taken from Institutional Review Committee of Nobel Medical College and Teaching Hospital (Ref IRC-NMCTH 437/2020). Obstetric patients  who presented with features of acute kidney injury characterized by oliguria (<400ml of urine in 24 hours) or rise in creatinine >1.02mg/dl were included in the study. Patients with preexisting renal disease or renal insufficiency before pregnancy were excluded from the study. Convenience sampling was done and the sample size was calculated as,2 × p × q / e2n = Z2 × (0.89) × (1-0.89) / (0.08)2  = (1.96)  = 59Where,n= minimum required sample sizeZ= 1.96 at 95% Confidence Interval (CI),5p= prevalence of complete renal recovery in acute kidney injury in pregnancy, 89%q= 1-pe= margin of error, 8%Minimum sample calculated was 59 and after taking a 10% non-response rate, a total of 66 eligible cases were enrolled into the study. Written informed consent was taken. Data were collected on a structured questionnaire and patient was followed daily till discharge and in six weeks' time.Variables studied were age, gravida, maximum serum creatinine level, need of dialysis, serum creatinine at discharge, serum creatinine at 6weeks follow-up and associated obstetric complications.6Acute kidney injury (AKI) was defined and classified according to Kidney Disease: Improving Global Outcome (KDIGO) criteria based on changes in serum creatinine or changes in urine output, or both, and it was categorized in stage 1 (increase in creatinine level by 1.5 times the baseline or urine output <0.5ml/kg/hr for 6-12hours), stage 2 (increase in serum creatinine level by 2 times the baseline or urine output <0.5/ml/kg/hr for ≥12hour) and stage 3 (increase in serum creatinine level by 3 times the baseline or creatinine level ≥4mg/dl or urine output <0.3ml/kg/hr for 24hours or anuria for ≥12hours).Data were entered in Microsoft Excel and imported to Statistical Package for the Social Sciences (SPSS) version 21 for analysis. Data were tabulated in frequency tables. Categorical variables were expressed as frequencies whereas continuous variables were expressed as mean and standard deviation. Point estimate at 95% CI was calculated.The prevalence of complete renal recovery in acute kidney injury was 45 (68.2%) (57-79.3 at 95% CI). Further sub-analysis were done in them and which showed the patient's age ranged from 18 to 35 years (24.1±4.69) and gravidity ranged from 1 to 5 (2.85 ±0.88). Among them, acute kidney injury occurred most commonly in third trimester 20 (44.4%) followed by postpartum period 15 (33.3%), first trimester 7 (15.5%) and second trimester 3 (6.6%). Preclampsia/Eclampsia was the most common cause of acute kidney injury in pregnancy 18 (40%) followed by sepsis 13 (28.8%) and hemorrhage 10 (22.2%). Other etiology of acute kidney injury was dehydration 2 (4.4%) and urinary tract infection/obstructive uropathy 2 (4.4%). Trimester wise distribution of causes of AKI is shown in In the patients with complete renal recovery, the rate of renal function recovery decreased significantly with increasing stage of AKI; 19 (90%) of Stage 1, 19 (86%) of Stage 2 and 7 (58%) of Stage 3 .Of these patients, 19 (54.2%) had intramural deliveries whereas 16 (45.7%) had extramural deliveries. Moreover, only 8 (17.7%) cases were booked cases. Among deliveries, 15 (42.8%) and 20 (57.2%) were preterm and term deliveries respectively. Of these, 16 (45.7%) were vaginal deliveries and 19 (54.3%) were cesarean section.The average creatinine was 2.32± 1.42mg/dl with minimum and maximum values of 1.1mg/dl and 6mg/dl respectively. Dialysis was needed in 4 (8%) cases. Stage wise distribution of obstetric factors associated with acute kidney injury .There were 2 (4.4%) cases of intrauterine fetal death and 1 (2.2%) cases of neonatal death.7 However, Goplani et al has noted renal recovery in only 54% while other studies has reported complete renal recovery as high as 89% cases.8Pregnancy related acute kidney injury has serious risk of maternal morbidity and mortality. Complete recovery of renal function occurred in 68.2% patients of AKI with lower recovery rate for higher stages of AKI. Study by Prakash et al also agreed to our finding which noted complete renal recovery in 69.4%.9 Similar to our study, Ansari, et al. also reported sepsis in 31% cases.10In the present study, preeclampsia/eclampsia was the most common cause of AKI followed by sepsis (40% and 28.8%). This finding agrees with that of Wang, et al. (49%) and Prakash, et al. (35.25%) which also showed that most common cause of AKI was due to preeclampsia.2The majority of women did not require hemodialysis and were managed conservatively. Dialysis was required only in 8% cases and all of them were Stage 3 AKI and this finding is similar to other studies.10AKI was more common in third trimester (44.4%) closely followed by postpartum (33.3%) and similar finding were noted in a study in Morocco whereas, study by Ansari, et al. noted AKI to be more common in postpartum period (75.6%).9The mean age of patient and gravidity were 24.1±4.69 years and 1 to 5 (2.85±0.88) and similar finding were reported in other studies.8 Other studies have noted high perinatal mortality ranging from 38.8% to 55%.11AKI was found to exist with increased perinatal complication like premature delivery (42.8%) and perinatal mortality (8.5%) in our study and similar finding were seen in study by Arora, et al.High number of cases of acute kidney injury in pregnancy in this hospital is due to late referral from periphery hospitals. Poor prenatal care, lack of well-equipped hospital in periphery, difficult road transport leads to delay in reaching tertiary hospital and in management followed by increasing severity of AKI. Majority of cases (82.3%) of acute kidney injury were unbooked cases and 45.7% cases had extramural deliveries which shows the need for early assessment and detection of morbidity for proper pregnancy care. Efforts are required to improve the coverage of prenatal care, especially in peripheral areas.9 But in the present study, this factor was not explored.In study by Prakash, et al. renal cortical necrosis was diagnosed in patients with incomplete recovery of renal function and its incidence was noted to have decreased from 17% in 1982-1991 to 2.4% in 2000s.The other limitation of this study was the small sample size and lack of long-term follow-up of the patient.The prevalence of complete recovery in obstetric patients with acute kidney injury was similar to other studies. The higher stage of AKI was seen with low recovery pattern such that least complete renal recovery occurred in Stage 3 AKI. This study is limited due to short follow-up so further studies are needed to understand the long-term outcome of AKI in pregnancy. Adequate antenatal care is needed to detect and prevent AKI and reduce poor long-term morbidity associated with this condition.


The 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines for the management of hypertension highlight the importance of fixed-dose combinations (FDC) for the treatment of hypertension and recommend initial single-pill combination therapy in almost all patients. However, data on the implementation of these recommendations in clinical practice are scarce.German Institute for Drug Use Evaluation (DAPI) were analyzed and extrapolated accounting for approximately 88% of Germany’s population (approximately 73.3 million subjects). All antihypertensive (AHT) FDC products available on the German market were included in the analyses. We examined the time course of dispensed packages between January 2016 and December 2020.Data from the FDCs accounted for 15.4% of all AHT in 2016 and for 10.9% in 2020. While dispensing of all AHT increased slightly from year to year , dispensing of FDCs decreased from 22.2 million (2016) to 16.6 million (2020) packs. Dispensing of FDCs containing hydrochlorothiazide (HCT) declined considerably from 2016 to 2020 . Accordingly, the proportion of HCT-containing combinations in all FDCs decreased from 85.3 to 74.2% from Q1 2016 to Q4 2020. Patients younger than 80 years were prescribed FDCs more frequently  than patients 80 years and older (10.0%). In both age groups, this proportion decreased continuously over time.Almost 2 years following the release of the 2018 ESC/ESH guidelines, only 10.9% of the prescribed packs of antihypertensive drugs in 2020 were FDC products, documenting underutilization of current guideline recommendations on pharmacotherapy in hypertension. Structured programs to evidence-based decision support are required to improve guideline inertia and patient outcomes, eventually. The 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines for the management of hypertension highlight the importance of fixed-dose combinations (FDC) for the treatment of hypertension and recommend initial single-pill combination therapy in almost all patients , 4. HoweGerman Institute for Drug Use Evaluation . The database contains anonymized dispensing data from more than 80% (until June 2019) and more than 95% (from July 2019 onwards) of Germany’s community pharmacies, claimed at the expense of the statutory health insurance (SHI) funds. Data were extrapolated by regional factors to 100% of the SHI-insured population, which accounts for approximately 88% of Germany’s population i.e., appr. 73.3 million subjects [The analysis is based on data from the We examined the time course of dispensed packages between January 2016 and December 2020 on a quarterly (Q) basis for all AHT FDC in total and separately for products with and without hydrochlorothiazide (HCT) as well as by drug classes. Furthermore, we analyzed dispensing in the age groups < 80 vs. ≥ 80 years.FDCs accounted for 15.4% of all AHT in 2016 and for 10.9% in 2020  and then considerably dropped to 3.13 million packs in Q4 2020. In contrast, FDCs without HCT showed a minor increase in dispensing from Q4 2018 onwards . Accordingly, the proportion of HCT-containing combinations in all FDCs decreased from 85.3 to 74.2% from Q1 2016 to Q4 2020 . In contrast, increases in dispensing was observed from Q4 2018 onwards in the third and fourth most common groups of ACEi + CCB  and ARB + CCB .The analysis by age group showed that patients younger than 80 years were prescribed FDCs more frequently  than patients 80 years and older (10.0%). In both age groups, this proportion decreased continuously over time Fig. .Fig. 3PrA high proportion of patients with hypertension fail to reach guideline recommended blood pressure targets . Among tp < 0.001) [p = 0.05 and − 1.54; 95% CI, − 2.67 to − 0.41; p = 0.0076). Rates of adherence and persistence were higher with FDC, which was in turn associated with better BP control [The use of FDCs in hypertension has been associated with several advantages, including improved medication adherence and persistence, and blood pressure outcomes when compared with free combinations. Of antihypertensive drugs, diuretics are more likely to lead to poor adherence, but adherence can be improved if diuretics are prescribed as fixed-dose combinations , 2, 11. < 0.001) . In a re control . Despite control . A study control . Beside  control . It is,  control , recentlThe majority of the approved FDC in Germany contain the diuretic HCT, which is one of the most frequently prescribed medications in Germany . RecentlThe current ESC/ESH hypertension guidelines recommend that older patients  should be offered blood pressure-lowering treatment if their systolic blood pressure is > 160 mmHg with a target of 130–139 mmHg. This should be achieved with lifestyle modification and, in most cases, antihypertensive drug therapy. In individuals older than 80 years of age, initiation of antihypertensive monotherapy is recommended [This analysis investigating the utilization of current guideline recommendations on pharmacotherapy in hypertension between 2016 and 2020 documented high rates of guideline non-adherence in Germany. Almost 2 years following the release of the 2018 ESC/ESH hypertension guidelines, only 10.9% of the prescribed packs of antihypertensive drugs in 2020 were FDC products, known to improve medication adherence and blood pressure control. Structured programs to evidence-based decision support are required to improve guideline adherence and patient outcomes, eventually.


Few studies have investigated pre-donation factors that could affect renal recovery after living kidney donation (LKD). We retrospectively investigated the role of John Cunningham virus (JCV) infection and other pre-donation factors on the magnitude of kidney function decline after LKD.Urine JCV viral loads, glomerular filtration rate, and blood pressure were evaluated in 60 consecutive LK donors before donation. Suboptimal compensatory hypertrophy was defined as an eGFR <60% of the pre-donation eGFR.st, 2nd, 3rd, and 4th years post-donation eGFR <60% of the pre-donation eGFR. Mean eGFR recovery at the 3rd year after donation was lower in JCV infected donors vs non-infected donors .LKD (40% JCV infected) were followed for 3.2±1.6 years. No association was found between age, gender, and baseline hypertension with 1We hypothesized that JCV could shift glomeruli into a hyperfiltration state before nephrectomy, modulating the magnitude of compensatory hypertrophy after donation. Conversely, JCV might curtail the ability of the remaining kidney to promote hyperfiltration. Longer follow up is needed to determine whether JCV viruria ultimately leads to lower eGFR over time or if it is a protective factor for the remaining kidney. This eGFR reduction has been associated with a rise in blood pressure, increased proteinuria, and change in left ventricular mass. Nevertheless, the consequences of eGFR loss after donation remain unclear. Available data regarding long term risks of living kidney donation (LKD) are conflicting and dependent on the selected control group. Some studies reveal a better vital outcome after LKD when compared to matched controls, while other studies show an increased risk of unfavorable outcomes, such as end-stage renal disease. Generally, kidney function after nephrectomy usually recovers up to 60-70% of baseline function through a compensatory hypertrophy mechanism. However, it is still unclear why the degree of compensatory hypertrophy is variable between donors. One possible mechanism is the presence of subtle metabolic syndromes or preclinical renal diseases before donation, which could potentially reduce the renal recovery capacity after donation.Living kidney donors have lower estimated glomerular filtration rate (eGFR) since unilateral nephrectomy inevitably leads to reduced renal mass and function and the central nervous system. Nearly 80% of adults are seropositive for JCV and approximately 30% of the adult population shed JCV in urine at any time point. With the exception of immunosuppression, factors that control the balance between latency and reactivation of polyomaviruses are unknown. Some studies unveiled a protective role of JCV against chronic kidney disease progression in selected populations. Polyomavirus viruria is not routinely measured before kidney donation, and, as far as we know, the potential role of JCV viruria on the development of de novo cardiovascular risk factors, in the magnitude of kidney function decline, or in new onset kidney disease in LKD is unknown.JC polyomavirus (JCV) is a human polyomavirus that cause asymptomatic childhood infection and persists in various sites including the urinary tractFew studies have investigated pre-donation factors that could affect the potential for recovery of kidney function after donation. Additionally, few studies evaluated the longitudinal performance of kidney function in LKD, which is preferable over a single point estimate.Hence, we conducted a longitudinal retrospective study to investigate the role of JCV viruria and other pre-donation factors on the decline of kidney function after LKD.In this single-center longitudinal retrospective study we enrolled 60 consecutive LKD (aged ≥18 years), followed in a Kidney Transplant Unit in Portugal, with at least one year of follow-up after donation.From May 2014 to February 2020, all 60 donors collected serum and urine prior to donation to evaluate JCV serum and urinary viral load status. Urine and plasma JCV viral loads were measured by quantitative commercial real-time polymerase chain reaction (qPCR). Whenever the screening for polyomavirus viruria was positive, the persistence of viral shedding was confirmed through another qPCR measurement at least 3 months after the first determination to evaluate the consistency of viruria, avoid false positive results, and evaluate variations in viral load over time.The study protocol complied with the Declaration of Helsinki and obtained full approval from the local clinical research ethics committee.Demographic data of LKD  was recorded at baseline.. The 24-hour proteinuria was measured at baseline in morning sterile spot urine samples. LKD candidates with proteinuria ≥200 mg/24 hours were excluded as donors.Before donation, GFR was measured through radioisotope renography and by classical creatinine measurement and was estimated through the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equationBefore donation, blood pressure (BP) was evaluated in all LKD through 24-hour ambulatory blood pressure (ABPM) measurement. Hypertension was defined as mean systolic BP >130 mg, diastolic BP >80 mmHg, or a controlled BP with at least one antihypertensive drug. Donors with hypertension were accepted at our center if the following criteria were fulfilled: no end organ damage  and average BP levels of 130/80 mmHg on ABPM under 2, or fewer antihypertensive drugs. After donation, BP was assessed by a physician in the follow-up visits as the mean value of 3 measurements.LKD candidates with type 2 diabetes mellitus or glucose intolerance were excluded from donation.Presence of cardiovascular risk factors (dyslipidemia and hypertension), urine protein/creatinine ratio, serum creatinine, and eGFR were collected at baseline and at post-donation follow up visits, which occurred at least once a year.After donation, optimal compensatory hypertrophy was defined as an eGFR ≥60% of the pre-donation eGFR, while the group of suboptimal compensatory hypertrophy included all donors with less than 60% of the pre-donation eGFR. We compared both groups for the following outcomes: post-nephrectomy development of hypertension, type 2 diabetes mellitus, glucose intolerance, dyslipidemia, proteinuria, and magnitude of kidney function decline.® technology, labelled with FAM fluorophore, is activated when it hybridizes with the specific product of JCV amplification reaction. Viral load is obtained through a calibration curve.A commercial real-time PCR technique (JCV ELITe MGB Kit) was used for JCV viral load determination. Two amplification reactions were performed starting from extracted DNA. A specific primer for the Large T antigen region of the JCV gene and a specific primer for an artificial sequence of DNA  were used. The JCV specific probe with ELITe MGBCategorical variables were described as absolute or relative frequencies. Continuous variables were described as mean ± standard deviation (SD) for normally distributed variables and median values and interquartile range for non-normally distributed variables. Proportions were compared using chi-squared test. Differences between clinical data were assessed by Student’s t test for unpaired samples for normal variables and Wilcoxon test for continuous data with non-normal distribution. A P value of <0.05 was considered statistically significant. All statistical tests were performed using the Statistical Package for the Social Sciences (SPSS) 25.0 software .A total of 60 LKD with a mean age of 50.9±12.0 years were enrolled in this study and followed-up for 3.2±1.6 years after donation.Clinical and demographical data at baseline are detailed in After donation, the average length of hospital stay was 7.3±1.7 days. At discharge, the mean eGFR was 62.1±14.9% of baseline eGFR.JCV viruria was not associated with age (p=0.261), baseline hypertension (p=0.321), measured GFR (p=0.38), or any baseline clinical or demographical parameter .De novo hypertension was diagnosed in 5 patients (8.3%). Only one patient developed overt proteinuria (>200 mg/g) after donation. Dyslipidemia was diagnosed in 9 (15%) patients and glucose intolerance or type 2 diabetes mellitus in 8 (13.3%) patients.Clinical outcomes after donation are described in st, 2nd, 3rd, and 4th year after donation , although this difference did not reach statistical significance.No difference was found in mean eGFR recovery at discharge and at 1 and 2 years after donation between JCV viruric and non-viruric donors . Neverthde novo hypertension after LKD .JCV viruria was not associated with In the present study we evaluated the role of JCV viruria on the magnitude of decline of kidney function after LKD for at least one year after donation. Additionally, we assessed the association of other pre-donation factors with measured renal function recovery after donation.. However, this risk is difficult to define, as GFR loss is physiologically observed with age. Therefore, the main question is whether kidney donation accelerates the decline in physiological GFR loss in addition to nephrectomy-related reduction in kidney mass and function, which is very difficult to demonstrate. In the present study, neither age, gender, or baseline hypertension were associated with achieving a post-donation eGFR less than 60% of the pre-donation baseline function 1, 2, 3, and 4 years after donation. Denic et al. investigated the relationships among kidney risk factors and revealed that mild hypertension and ageing were risk factors for underlying abnormalities such as nephrosclerosis and nephron hypertrophy in donors. However, van Londen et al. showed that the GFR slope was not associated with hypertension, which could be explained by the practice of accepting only low-risk hypertensive donor candidates.The risk of kidney dysfunction after LKD is a major concern, and therefore, it is crucial to optimize donor selection to reach the best outcomes after donation. Furthermore, Young et al. conducted a meta-analysis of 3 studies that assessed the post-donation change in eGFR in 23 older and 541 younger donors. The meta-analysis found that older donors had a lesser decline in eGFR compared to younger donors . Therefore, it was shown that older donors do not have a long-term deterioration of renal function, which is in line with our results.Okumura et al. followed 133 LKD for one year and concluded that age, sex, and hypertension were significant preoperative predictors for patients who lost >40% of their eGFR 1 year after LKD. The small number of patients with baseline hypertension (n=11) and male gender (n=17) could contribute to the lack of statistical association.Although we did not find an association between gender and renal function after donation, several studies revealed that the male gender is an independent risk factor for deterioration of renal function after donationDe novo hypertension was diagnosed in 5 patients (8.3%) after donation. The literature regarding the incidence and prevalence of hypertension following LKD is inconsistent in study design and outcomes. Moreover, the prevalence of hypertension also increases with age in the general population. It is still unclear whether or not there is a significant risk of hypertension in donors compared to the general population. Nevertheless, hypertension is a heterogeneous phenomenon, affecting donors in different degrees and may be influenced by several factors. five years post donation. Similarly, in our study, only one patient developed overt proteinuria after donation.Londen et al. found that only 2% of donors developed proteinuria >0.5 g/day. The authors followed 41,260 LKD and showed that at 6 months, 1 year, and 2 years after donation, there were 2, 6, and 15 cases of diabetes per 10 000 donors, respectively. As our sample was small, it was impossible to achieve a definite conclusion.After donation, dyslipidemia was diagnosed in 9 (15%) patients and glucose intolerance or type 2 diabetes mellitus in 8 (13.3%) patients. Data regarding the development of dyslipidemia after LKD are lacking. However, according to Holscher et al., the development of diabetes after LKD is a rare phenomenon. Nevertheless, asymptomatic urinary shedding of JCV has shown conflicting results. In a Brazilian study, the prevalence of JCV viruria in a healthy control group was 20.1%. Moreover, Rodrigues et al. noted a 23.9% urinary excretion of JCV in the general population in Portugal. However, in a group of 120 African American non-nephropathic individuals, prevalence of JCV varied between 40% for APOL1 the renal-risk genotype group and 48.8% for APOL1 the non-risk genotype group. Our results are in line with the former study, considering the higher incidence of JCV viruria (40%).JCV appears to establish a benign latent infection in reno-urinary epithelium with periodic reactivation and viral excretion in urineWe aimed to confirm the persistence of virus shedding before donation. JCV viruria was consistent between the 2 measurements in all 24 JCV viruric donors. Therefore, an isolated positive sample is enough to define the state of JCV urinary carrier. tested whether infection by JCV and BKV modulated the association between APOL1 and development of nephropathy. They found that the presence of JCV viruria in patients with increased risk of APOL1-associated nephropathy was negatively associated with albuminuria and CKD (eGFR <60 mL/min/1.73 m2). The authors postulated that JCV may interact with APOL1 genotypes to modulate kidney disease risk.Some recent reports have described a potential protective association between JCV viruria and kidney disease. Divers at al. of African American individuals with mild-severe CKD, JCV viruria was present in 45.8% of non-nephropathy controls and in 8.75% of CKD cases regardless of APOL1 renal-risk genotype status. The authors postulated that JCV had a robust CKD protective effect [OR (95% CI) 0.15 (0.06-0.42)]. These results were further extended to African Americans with diabetic kidney disease and to Black South Africans with hypertension-attributed CKD.In a subsequent analysisOur study showed conflicting results. JCV viruria was not associated with any baseline parameter of LKD, including measured GFR or eGFR. This fact was probably due to the absence of patients with reduced renal function.. Unexpectedly, we found that mean eGFR recovery 3 years after donation was lower in JCV viruric donors compared with non-viruric donors . Four years after donation, eGFR recovery was also lower in JCV viruric donors , although this difference did not reach statistical significance, probably due to the small number of patients in the analysis (n=23). The reason why JCV viruria associates with blunted kidney function recovery 3 years after donation remains undetermined.Post-donation renal function is approximately 60% of baseline function due to adaptive hyperfiltration and hypertrophy of the remaining kidney. Renal hyperfiltration and increase in intraglomerular pressure could eventually lead to a deleterious effect on kidney function with time. Furthermore, the reason why compensatory adaptation differs among donors is unclear. Previous studies postulated that preclinical renal diseases could affect renal recovery after donation. We hypothesized that JCV could shift glomeruli into a hyperfiltration state before nephrectomy, modulating the magnitude of compensatory hypertrophy after kidney donation; thus, at mid-term, the potential of adaptive increase of GFR in these patients might be lower than in patients who did not shed JCV. Conversely, JCV might limit the ability of the remaining kidney to promote hyperfiltration, which might actually be a protective mechanism, as long-term hyperfiltration may be deleterious. Several approaches to protect against renal function deterioration target hyperfiltration, including renin-angiotensin-aldosterone system blockade or sodium-glucose cotransporter 2 (SGLT2) inhibition. Longer follow-up is required to evaluate long-term effects on kidney function.After nephrectomy, the remaining kidney develops a functional adaptation through an increase in renal filtration of nephrons due to the increase renal plasma flow, which is accompanied by an increase in intraglomerular pressurede novo comorbidities. Furthermore, its retrospective nature does not allow to establish causality. Due to the low incidence of suboptimal compensatory adaptation in the remaining kidney, a more sophisticated statistical analysis, including multivariate analyses, was not possible. Also, we used estimated GFR to analyze the magnitude of kidney function decline after donation, which could overestimate decline. However, the use of eGFR is common in most transplant centers and is in agreement with recent guidelines.Our study has several limitations: it is a single-institution study with a small sample size. The follow-up of up to 4 years after donation is relatively short for evaluating the effects of baseline parameters on post-donation outcomes and on the development of A major strengths of our study is the longitudinal assessment of kidney function, unlike most studies that examine only a single time-point after donation. Furthermore, as far as we know, this is the first study to examine the role of pre donation JCV viruria in post-LKD outcomes. Longer follow-up is needed to determine whether JCV viruria ultimately leads to lower eGFR over time or if it is a protective factor for the remaining kidney.In conclusion, although we are aware that these data cannot establish a cause-effect relationship, we believe that this is a hypothesis-generating article on a previously unknown association between JCV and blunted recovery of renal function after kidney donation. Therefore, these findings may draw attention to this possible association, which can be clarified in future larger prospective studies. In addition, two potential explanations for the role of JCV infection in glomerular hyperfiltration are suggested for future evaluation.


Blood pressure variability (BPV) is associated with cardiovascular and all-cause mortality, and has been demonstrated in dialysis patients, but has been poorly studied and remains controversial in non-dialysis chronic kidney disease (CKD) patients. We investigated the effect of short-term BPV on prognosis in this population.A total of 245 stage 1–4 CKD patients with 24-h ambulatory blood pressure recordings were recruited. BPV was evaluated by standard deviation, coefficient of variation, and variation independent of the mean, respectively. All subjects were followed up to the composite end-point event or until January 15, 2020. Patients were divided into two groups based on 24-h median variation independent of the mean, and demographics, laboratory indicators and echocardiogram results were compared. Logistic regression was used to analyze the risk factors for increased BPV. Multivariate Cox regression and Kaplan-Meier survival analysis were used to explore the relationship between BPV and renal prognosis and major cardiovascular events.P = 0.017), hyperkalemia , increased left ventricular end-diastolic diameter  and hypertension  were independent risk factors for high BPV. Kaplan-Meier survival analysis showed that renal and cardiovascular outcomes were better in the low BPV group than in the high BPV group . After adjusting for age, sex and traditional kidney related risk factors, BPV were not independently associated with renal outcomes. High BPV  was the main independent risk factor for major cardiovascular events in CKD.The mean age was 42.07 ± 12.66 years, with 141 males (57.55%). Multivariate Logistic regression analysis showed that high BMI (OR 1.110, In non-dialysis CKD, short-term BPV was associated with major cardiovascular disease but not renal progression. BMI, hypertension, potassium balance, and left ventricular end-diastolic diameter influenced short-term BPV. Problems associated with aging are becoming more and more severe throughout the world and high blood pressure (BP) is prevalent in the elderly. Epidemiological data indicate that the global prevalence of CKD is approximately 8–16% and increasing from year to year .Poor control of hypertension can result in kidney damage or worsen the initial kidney, or cardiovascular disease. A study in China showed that the awareness rate of hypertension in CKD patients was 80.7%, the treatment rate was 95.6%, but the control rate was only 57.1% . BP fluc-4 CKD patients who have not yet started renal replacement therapy, does this relationship still exist? We conducted a single-center retrospective study on this issue.The fluctuation of BP over a certain period of time is called blood pressure variability (BPV), including long term (visit-to-visit), mid-term (day-by-day), short term (within 24h) and very short term (beat-by-beat) BPV. Prior studies have demonstrated that BPV independent of mean BP is associated with the occurrence of cardiovascular disease , 7 as weThis was a retrospective, longitudinal, observational study performed in the Department of Nephrology, General Hospital of Ningxia Medical University on all non-dialysis CKD patients who were diagnosed and followed up regularly from January 1, 2012 to December 31, 2018. The inclusion criteria were age >18 but <70, those with a follow-up time of ≥1 year, and those who completed 24-h ambulatory blood pressure monitoring (ABPM). We excluded patients who had undergone renal replacement therapy, including hemodialysis, peritoneal dialysis, kidney transplantation, or patients with a history of clearly diagnosed cardiovascular and cerebrovascular diseases, including coronary heart disease, myocardial infarction, malignant arrhythmia, cerebral infarction, cerebral hemorrhage and those with any tumor or those with missing follow-up data. All patients voluntarily participated in this study and signed an informed consent form. This project was approved by the Ethics Committee of Ningxia Medical University.2) and previously diagnosed chronic diseases. Laboratory tests performed on the enrolled patients included blood potassium, sodium, calcium, phosphorus, albumin, hemoglobin, 24-h urine protein quantification, uric acid, blood urea nitrogen, creatinine, and eGFR , The composite endpoints included the occurrence of renal progression , major cardiovascular events  and death. The study termination was January 15, 2020, or the occurrence of any of the endpoint events for individual patients. Follow-up was done on an outpatient basis and by telephone every 1–3 months.Patients were divided into two groups based on the median 24 h systolic blood pressure VIM at baseline. (1) high BPV group (VIM >11.96) and (2) low BPV group (VIM ≤ 11.96). The demographic information collected on patients included age, gender, smoking history, BMI , coefficient of variation (CV = SD / mean), and variation independent of the mean (VIM) to quantify the 24 h blood pressure variation range. The VIM was calculated according to the following formula:X, where X is the curve–fitting coefficient of each patient's SD (dependent variable) and mean is the BP mean (independent variable); and k = MX, where M is the mean blood pressure of all subjects , left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic diameter (LVDD), left ventricular ejection fraction (LVEF) and body surface area (BSA) were recorded to calculate left ventricular mass (LVM) and left ventricular mass index (LVMI).3- LVDD3]+0.6Devereux  LVM(g) =LVMI (g/m) = LVW/BSABSA  = 0.0061T-test was used to compare the two groups with normal data, and a non-parametric test was used to compare the two groups with non-normal data. The chi-squared test was used to compare the counting data between groups. The Kaplan-Meier method was used to analyze the relationship between BPV and kidney prognosis and major cardiovascular events. We used multiple Logistic regression analysis to explore the factors of BPV. A multivariate Cox regression model was used to analyze the risk factors of renal prognosis and cardiovascular and cerebrovascular events. The difference was statistically significant at P < 0.05), and α = 0.05 was the test level.The data are expressed as mean ± standard deviation for normal distribution, and the non-normal data are expressed as median . 2, with 102 (41.63%) patients in stage CKD1, 67 (27.35%) in stage CKD2, 59 (24.08%) in stage CKD3, and 17 (6.94%) in stage CKD4.This study investigated 271 patients with non-dialysis CKD who underwent 24 h ABPM. We excluded 12 patients with incomplete data, four patients with previously diagnosed cerebrovascular disease, and two patients older than 70 years. Eight patients were excluded because of lack of follow-up. Ultimately, we included 245 non-dialysis stage 1–4 CKD patients to study the relationship between short-time BPV and the outcomes. There were 141 males (57.55%) and the average age was 42.07 ± 12.66 years. There were 135 patients with hypertension (55.1%) and 31 patients with diabetes (12.65%). With respect to etiology, there were 212 patients (86.53%) with primary glomerular disease, 13 (5.31%) with diabetic nephropathy, 10 (4.08%) with hypertensive nephropathy and 10 with other diseases. Renal biopsy was performed on 185 subjects, among which 78 (42%) had IgA nephropathy, 55 (30%) had membranous nephropathy and 18 (10%) patients had glomerular microlesions as the main pathological types, while 34 patients exhibited other pathological types. P = 0.002). This trend persisted even when SD and CV were used as quantitative indicators of blood pressure variability  (Blood pressure variability (VIM = 15.03) in patients with CKD4 was significantly greater than that in patients with CKD1 (VIM = 11.89) (= 0.032) .P = 0.079). In terms of clinical indices, the blood potassium, uric acid and urinary protein were higher in the high BPV group, but there was no significant difference in serum creatinine distribution. In addition, the patients in the higher BPV group had greater left ventricular thickness and left ventricular mass, which also meant they had larger hearts and limited diastolic and systolic function.Patients in the higher BPV group were older, had higher BMI, and higher average BP. There was no difference in the distribution of BPV between men and women or between the low and high groups (P <0.1) in the multivariate logistic regression analysis to determine the risk factors for increased BPV. High BMI , hyperkalemia , increased left ventricular end-diastolic diameter  and hypertension  were all statistically significant as risk factors for elevated BPV (We included the above variables (ated BPV .P < 0.05), but there was no statistical difference in all-cause mortality (P > 0.05). After Kaplan-Meier survival analysis, renal prognosis in the low BPV group was significantly greater than that in the high BPV group . Similar results were also seen in major cardiovascular prognosis. Patients in the low BPV group had better cardiovascular outcomes than those in the high BPV group during follow-up  (P = 0.009). However, the association disappeared in fully adjusted models. High SBP-VIM (> VIM 11.96) was always associated with the occurrence of cardiovascular events in both unadjusted and fully adjusted models   . The ass= 0.022) .P = 0.006) and higher risk of major cardiovascular events in (P = 0.002). We also demonstrated that high SBP-VIM (> VIM 11.96) was independently associated with major cardiovascular events but not renal progression in patients with pre-dialysis CKD. Most studies have shown that long-term and short-term BPV were associated with target organ damage  and all-cause death in the general population , a total of 44 end-point events occurred. With the Kaplan-Meier survival analysis, we observed that the high VIM group with low VIM had worse renal prognosis  of systolic BPV . In a stIt is clear that the definition of BPV is not unequivocal. In the case of traditional ‘dippers' , non- dippers , inverted dippers  and extreme dippers  current methods can only represent the variation of BP at night. They have no capacity for quantifying the variation of BP throughout the whole 24 h or even during observation. Several studies have confirmed that the prevalence of the non-dipper BP pattern in patients with CKD is higher than that in patients with essential hypertension and is related to damage of the kidney, cardiovascular system and other target organs in patients with CKD –30. ReseIt was noted that some prognostic studies also found numbers of biomarkers associated with end-stage renal disease (ESRD) or cardiovascular events in patients with CKD. Some of these biomarkers may have analyzed the etiological and predictive links demonstrated with clinical results. Cystatin C is a low molecular weight protein produced by nucleated cells that is freely filtered through the glomerulus and not secreted by renal tubules. It is completely reabsorbed. Shin et al. found that cystatin C was a better predictor of cardiovascular events and mortality than creatinine or Egfr . FGF-23 The limitations of this study are mainly in the following aspects. First, we are not able to clarify the casual relation between high BPV and the kidney outcome and major cardiovascular events in non-dialysis CKD patients. In this study, the patients' conditions were relatively mild at enrollment. 169(69%) patients in stage 1 and 2 CKD, and the number of endpoint events observed was small. Thus, our study may be underpowered to detect adverse kidney outcomes within the specific follow-up time. Second, single-center retrospective assessments with small sample size may have bias that is difficult to account for. Third, although we found that BPV was independently associated with several factors such as larger BMI and hyperkalemia in our study, the mechanisms between them are not particularly well defined. In particular, the pathophysiological mechanisms between blood potassium levels and BPV need to be confirmed in animal models or in randomized controlled trials. In the future, large-sample, multi-center, prospective clinical studies are needed to further explore the impact of BPV on the prognosis of CKD patients, and whether lowering BPV can delay the progression of non-dialysis CKD and improve the prognosis. Lastly, due to the limitation of time and data, we only analyzed the effect of BPV at baseline on prognosis of enrolled patients. However, over the long course of CKD, there are many factors affecting BPV that cause it to change dynamically, and how to detect and manage them will require much future effort.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.GW conceived, designed, and coordinated the writing of the whole manuscript. KM, XG, and YL revised literature. ZM and LM provided clinical study of this work and collected clinical data. YW and CQ made statistical analysis. XZ took part in study design and responsible for the final draft. All the authors contributed to this manuscript and approved the submitted version.This paper was supported by Ningxia Science Foundation (Project number: 2019A0288) and Foundation for Returned Scholars of Ningxia (Project number: 2017659).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The results indicate that patients with bilateral renal artery involvement and younger age at hypertension onset are more likely to have poorer clinical outcomes after PTRA, and should be more closely monitored.Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease involving small-to-medium-sized arteries. The characteristics of Chinese patients with FMD remain unclear. We retrospectively analyzed the data of patients with renal FMD who underwent percutaneous transluminal renal angioplasty (PTRA) for the first time at Fuwai Hospital between 2010 and 2021. The variables were selected through least absolute shrinkage and selection operator regression (LASSO), and logistic regression models were constructed to identify independent risk factors. A total of 116 patients  were enrolled. Elevated blood pressure was the leading complaint. After a median follow-up period of 18.0 months (interquartile range: 6.0–48.0 months), hypertension recurred in 34 patients and restenosis in nine patients, among whom four patients underwent secondary intervention and one patient underwent surgical revascularization. Bilateral renal artery involvement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.11–6.15;  Fibromuscular dysplasia (FMD) is a segmental, non-atherosclerotic, non-inflammatory vascular disease that affects small-to-medium-sized arteries . HistoloFMD can occur in people of all ages and can involve multiple vascular beds. However, it primarily occurs in middle-aged individuals, and the most frequently affected vessels are the renal and cerebrovascular arteries. Although the exact cause of FMD remains elusive, it is commonly recognized that the interaction of both genetic and environmental factors, including smoking, mechanical stimulation, and hormone factors, contribute to FMD pathophysiology and development ,4,5. ThePresently, percutaneous transluminal renal angioplasty (PTRA) and surgery for revascularization are considered the most efficient treatment options based on the clinical symptoms of the lesions and the degree of stenosis. The small lesion size and possibility for re-intervention promote PTRA as the appropriate first-line treatment option for renal FMD.Although several studies have investigated the short-to-long-term outcomes of PTRA in Western populations, related studies in Eastern populations are scarce. Previous studies have shown that Chinese patients differ from Western patients in terms of sex distribution and disease type, indicating that the Chinese FMD population might represent a separate entity ,13. ThusThe data of patients diagnosed with FMD at Fuwai Hospital between January 2010 and December 2021 were retrospectively reviewed. The inclusion criteria were (1) a diagnosis of renal artery FMD, and (2) renal artery intervention for the first time at our institution. FMD was diagnosed as nonatherosclerotic arterial encroachment or stenoses affecting the trunk or branches of medium size arteries based on catheter-based angiography, computed tomography angiography (CTA), magnetic resonance angiography (MRA), in the absence of aortic wall thickening, biochemical evidence of inflammation, and known syndromic arterial disease  . This stThe basic treatment of patients with FMD included antihypertensive medication to control blood pressure and revascularization, with PTRA being the first choice. Angiography was performed by experienced clinicians. PTRA was recommended if the diameter of the renal artery was reduced by more than 70% on angiography. PTRA was considered successful if residual stenosis was <30%; otherwise, patients were advised to undergo surgery or stent implantation. Renal function indices and blood pressure were measured using a catheter after PTRA.Ostial lesions were defined as being within 0.5 cm of the main renal artery ostium, and proximal lesions were defined as being >0.5 and <1 cm from the renal artery ostium. Distal lesions were within 10 mm of the end of the main renal artery. Focal FMD was defined as isolated stenosis , comprisOutcomes, including all-cause death, hypertension recurrence, restenosis/revascularization, and stroke were investigated during follow-up. Recurrent hypertension was defined as recurrence of a diastolic blood pressure of ≥90 mmHg, a systolic blood pressure of ≥140 mmHg based on daily regular measurements, or a ≥20% increase in post-procedural diastolic blood pressure that was not treatable by repeat angioplasty . RestenoThe clinical information of the enrolled patients was collected, including demographics, symptoms, comorbidities, family history, and laboratory data. All data related to PTRA were collected through the electronic medical records system.All patients underwent education and standard training of automated upper arm blood pressure measurement devices before discharge. The baseline blood pressure of the patient was defined as average blood pressure standardly measured at home within one week after discharge by means of the automated upper arm devices, and the same device was used for blood pressure monitoring during follow-up. Home blood pressure level is the average of all blood pressure readings performed with an automatic upper arm device, for 6–7 consecutive days, with readings in the morning and the evening, taken in a quiet room after 5 min of rest, with the patient seated with their back and arm supported. Two measurements should be taken at each measurement session, performed 1–2 min apart. All the devices used had been validated according to agreed-upon criteria, which meet the validation protocols of the American Association for the Advancement of Medical Instrumentation and the British Hypertension Society ,20. As fp value of <0.05 was considered statistically significant.SPSS (version 26.0) and R (version 4.2.0) software were used for the statistical analyses. Data are presented as the mean ± standard deviation or as the median and interquartile range (IQR). Categorical data are presented as frequency (percentage). The Wilcoxon rank-sum test was used to compare the clinical data of patients before and after PTRA. Risk factor estimation of the outcomes was performed using a combination of least absolute shrinkage and selection operator (LASSO) and univariate/multivariate logistic regression analyses presented as measures of association. A A total of 136 patients were diagnosed with renal artery FMD between January 2010 and December 2021 at Fuwai Hospital. Seven patients who did not undergo PTRA, two patients with concomitant atherosclerotic renal artery stenosis (both age >50 years with cardiovascular risk factors including hyperlipemia and diabetes), five patients with concurrent severe extrarenal FMD, three patients who underwent PTRA for the first time at other hospitals, and three patients in whom PTRA failed due to failure of the guidewire to pass through the stenosis were excluded. Finally, the data of 116 eligible patients diagnosed with renal artery FMD who underwent renal artery intervention for the first time were included and analyzed. The patient characteristics are presented in A total of 119 patients underwent angiography, and the technical success rate of PTRA was 93.3% (111 of 119). The eight patients with technical failure included three patients in whom the guidewire failed to pass through the stenosis and five patients with residual stenoses of >30% and <50% after PTRA. Excluding the three patients in whom the guidewire failed to pass through the stenosis, the detailed information about 116 cases of renal artery involvement is displayed in p = 0.007). Moreover, the degree of stenosis was smaller in ≥30 (p = 0.047) (p = 0.001) in all patients.Previous studies performed in the Western population have shown significant differences in terms of age at hypertension diagnosis and at the first intervention compared to the present study in Chinese patients. Thus, based on the present population, we divided the patients into two groups based on their age at first FMD diagnosis (≥30 years and <30 years). In this subgroup analysis, the duration of hypertension in patients aged ≥30 years was longer than the duration of hypertension in the group aged <30 years (= 0.047) . The durp = 0.028) and age at hypertension onset  were significant independent prognostic factors for adverse outcomes in both models. Considering that Chinese FMD patients may be an independent group, which is different from the Western population, we divided the patients into two groups based on the median age at hypertension onset of 21.5 years. The subgroup analysis showed that age at hypertension onset of <21.5 years  was a significant independent risk factor for adverse outcomes, and the baseline characteristics of ≥21.5 years and <21.5 years groups was not significantly different. The results also show that the lesion in the subgroup with bilateral renal artery involvement was longer  and multifocal-type disease was more common  than in the unilateral renal artery subgroup.The median follow-up period was 18.0 months (IQR: 6.0–48.0 months). In diagnosing hypertension recurrence, we also referred to the blood pressure level at discharge to avoid overdiagnosis, especially in the early time enrolled patients. Finally, hypertension recurrence occurred in 34 patients, two of whom suffered from stroke. Restenosis occurred in nine patients, of whom four underwent secondary intervention and one underwent surgical revascularization. The potential risk factors for events were selected using the LASSO method  and predThe present study retrospectively analyzed the clinical data of a large sample of East Asian individuals with FMD with a mid-to-long-term follow-up period. Using these data, we evaluated the PTRA outcomes to identify the risk factors that might affect prognosis.Since FMD was first described in 1964 by Palubinski and Ripley in a woman with evidence of internal carotid artery fibromuscular hyperplasia , severalIn both Western and Eastern patients, hypertension is one of the most frequent presenting symptoms associated with renal FMD . Based oAlthough pathology is the gold-standard diagnostic method, catheter-based angiography is of great value as it can provide more details about FMD. According to angiographic images, FMD can be classified into multifocal and unifocal forms, of which the former is the most common type in Western FMD populations . Of notep < 0.0001) and the number of antihypertensive drugs  decreased after undergoing PTRA during the 7-year follow-up period [PTRA is considered the first-line treatment for renovascular hypertension caused by FMD. In the present study, the technical success rate of PTRA was 93.3%, and the effects on blood pressure and renal function, including creatinine, blood urea nitrogen, and uric acid concentrations, decreased significantly after PTRA. Of note, the decrease in plasma creatinine levels after PTRA was slight, which may be associated with the occurrence of early kidney injury in patients with chronic severe hypertension and the use of contrast media during PTRA procedure. With the increase in research on FMD, the number of studies on the efficacy of PTRA in patients with renal FMD is gradually increasing. A meta-analysis of 47 angiography studies involving 1616 patients with FMD revealed that the hypertension cure rate after revascularization was 40%–52% . Moreovep period . The lonp period . In thisAll patients face the risk of restenosis, which requires re-intervention after PTRA. The statistical analysis indicated that bilateral renal artery involvement and younger patients had a higher risk of restenosis. We also found that a younger age at hypertension onset increased the likelihood of mid-term adverse outcomes. A meta-analysis conducted in 2010 revealed that the mean age was younger among cured patients , which iWe found that bilateral renal artery involvement was a risk factor for adverse outcomes after PTRA. In this study, unilateral stenosis (72.4%) occurred more frequently than bilateral stenosis (27.6%), which is similar to a previous report by Alhadad et al. . StudiesThis study has some limitations that should be noted. First, this is a single-center retrospective study with inescapable referral bias, which stemmed from the transfer of patients from subordinate hospitals. Second, we only examined the mid-term follow-up records of these patients; thus, further monitoring of long-term follow-up records should be performed in the future. Third, the data on age at hypertension onset and hypertension duration were collected from the patient’s chief complaint records; thus, the time of severe renal artery stenosis may not be accurate. Fourth, except for the nine restenosis and two stroke patients, other patients’ blood pressure levels during follow-up were obtained from home blood pressure monitoring. Although we conducted patient education and training before discharge, home blood pressure monitoring compliance was not optimal in all patients. Finally, baseline home blood pressure was lacking for the patients enrolled in the early period. We nevertheless collected their office blood pressure, and medical records and referred the pressure to the office blood pressure at discharge when diagnosing the outcome.In summary, FMD is a heterogeneous, systemic, non-inflammatory, non-atherosclerotic disease of the arterial wall, which often involves the renal arteries. We report in detail the characteristics of 116 Chinese patients with renal FMD and show that PTRA is an effective treatment strategy. Younger age at hypertension onset and bilateral renal artery involvement might be associated with poorer clinical outcomes. However, this remains to be verified in large-scale and prospective studies.