Diabetic nephropathy (DN) is the most common cause of end-stage renal disease (ESRD), both in the USA and in Europe; moreover, its incidence is rising worldwide. The main laboratory markers of DN progression are albuminuria and a reduction in glomerular filtration rates, although progression of the disease has been observed even in the absence of these biomarkers. Renal impairment, associated with diabetes, results from damage to the glomerular filtration barrier, at the level of highly differentiated glomerular epithelial cells: podocytes. These cells regulate glomerular filtration and many immunological processes occurring at this level. The earliest possible diagnosis of diabetic kidney disease (DKD) and implementation of intensive treatment offers the possibility of preventing or substantially delaying the onset of ESRD. In this article, we review various urinary biomarkers linked with glomerular podocyte cytophysiology as potentially sensitive diagnostic tools for the early detection of DKD. These biomarkers have predictive potential for assessing the progression toward end-stage nephropathy.

Clostridioides difficile infection (CDI) is a leading cause of a healthcare-associated diarrhea worldwide. Recently, an increased number of new cases and growing mortality due to CDI have been observed. Patients suffering from end-stage renal disease (ESRD) are most exposed to CDI. It has been proven that CDI in patients receiving renal replacement therapy (RRT) significantly increases mortality, prolongs hospitalization and increases the cost of treatment. Important risk factors of CDI in ERSD patients include hospitalization or stay in an intensive care unit in the last 90 days, HIV infection, bacteremia, prolonged antibiotic therapy and hypoalbuminemia. Cirrhosis, age over 65 years, hypoalbuminemia, longer hospitalization time and use of antibiotics are significant risk factors of death. Effective methods of preventing CDI include hand hygiene with soap and water, isolation of infected patients in a private room with a dedicated toilet, the use of masks, gloves, disinfection of the environment and systematic education and control of medical personnel, as well as rational antibiotic policy. In addition, it is important to avoid antibiotics with a proven risk of CDI, caution use of proton pump inhibitors (PPI) and H2 receptor antagonists. It is also important in the prevention of CDI in people with ERSD, to apply a fast diagnostic since the onset of the first symptoms. The use of probiotics and bile acids in the primary prevention of CDI requires further research. It seems that knowledge of these factors and methods of prevention will significantly reduce morbidity and mortality due to CDI.

In patients with CKD, longer hospitalization time and lower serum albumin concentration significantly increased the risk of the C. difficile infection. The C. difficile infection, age, the number of used antibiotics, longer hospitalization time, and lower initial serum albumin concentration notably augmented the risk of death. Although the incidence of the C. difficile infection did not correlate with the estimated glomerular filtration rate (eGFR), 67% of patients who tested positive were class 5 of CKD, whereas only 5.7% were class 1.

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The majority of recently published studies indicate a greater incidence rate and mortality due to Clostridioides difficile infection (CDI) in patients with chronic kidney disease (CKD). The aim of this study was to assess the clinical determinants predicting CDI among hospitalized patients with CKD and refine methods of prevention. We evaluated the medical records of 279 patients treated at a nephrological department with symptoms suggesting CDI, of whom 93 tested positive for CDI. The survey showed that age, poor kidney function, high Padua prediction score (PPS) and patients’ classification of care at admission, treatment with antibiotics, and time of its duration were significantly higher or more frequent among patients who suffered CDI. Whereas BMI, Norton scale (ANSS) and serum albumin concentration were significantly lowered among CDI patients. In a multivariate analysis we proved the stage of CKD and length of antibiotics use increased the risk of CDI, whereas higher serum albumin concentration and ANSS have a protective impact.

Background Fibrosis constitute the main complications associated to Crohn′s disease (CD). NOTCH signalling has been implicated in lung, kidney, liver and cardiac fibrosis. Macrophages contribute to fibrosis through the release of different mediators and the pattern of secretion may vary according to their microenvironment. The aim of the present study is to analyze the role of NOTCH ligands derived from macrophages in the complications of CD. Methods The aim of the present study is to analyze the role of NOTCH ligands derived from macrophages in the complications of CD. We have analyzed: the protein expression of NOTCH ligands and receptors in CD patients with fistulizing (B3) and stenting pattern (B2), the protein expression of NOTCH ligands in macrophages treated with the main cytokines present in CD patients (IFNγ-, IL10-, IL4, TNFα-U937 treated cells), the protein expression of HES1 and fibrosis markers in DLL4-HT29 and DLL3-HT29 treated cells. Results are expressed as fold induction (mean±SEM). Statistical analysis was performed with one-way ANOVA followed by Newman-Keuls test or t-tet. Results The expression of DLL4 and NOTCH4 were significantly higher in intestinal samples from B3 CD patients (3,2 ± 0,6 N=4* and 3,8 ± 0,6 N=8*, respectively) than in B2 patients (1,6 ± 0,2 N=4 and 1,7 ± 0,3 N=8, respectively) and controls (1,0 ± 0,1N=3 and 1,0 ± 0,1 N=8, respectively). IFNγ-U937 treated cells increased significantly the protein expression of DLL3 and DLL4 (1,6 ± 0,09 N=6* and 1,3 ± 0,1 N=7*, respectively) respect vehicle; IL4 increased significantly the expression of DLL4 (1,4 ± 0,1 N=7*) and TNFα increased significantly the expression of DLL3 (1,4 ± 0,1 N=5*), respect vehicle. DLL4-HT29 treated cells increased significantly fibrosis markers (VIMENTIN: 1,7 ± 0,1 N=3*; SNAIL: 2,2 ± 0,2 N=3*) and HES1 (1,4 ± 0,06 N=3*), respect vehicle (1,0 ± 0,07 N=6; 1,0 ± 0,05 N=6; and 1,0 ± 0,05 N=6, respectively). DLL3-HT29 treated cells only produced a reduction in the protein expression of ECADHERIN (0,4 ± 0,1 N=3*), respect vehicle (1,0 ± 0,09 N=6). Conclusion Macrophages may act as a source of NOTCH ligands who could act as fibrosis mediators in CD patients with a fistulizing (B3) behavior. The microenvironment rich in IFNγ could activate the fibrosis process in epithelial cells by favoring the expression of DLL4 and DLL3 in macrophages. DLL4 mainly activates transcription factors involved in mesenchymal epithelial transition in colonic epithelial cells (SNAIL), while DLL3 seems to have a more relevant role in cell-cell junction modification (ECADHERIN).

The majority of recently published studies indicate a greater incidence and mortality due to Clostridioides difficile infection (CDI) in patients with chronic kidney disease (CKD). Hospitalization, older age, the use of antibiotics, immunosuppression, proton pump inhibitors (PPI), and chronic diseases such as CKD are responsible for the increased prevalence of infections. The aim of the study is to identify clinical indicators allowing, in combination with artificial intelligence (AI) techniques, the most accurate assessment of the patients being at elevated risk of CDI.

Celiac disease (CD) is an immune-mediated disease, caused by gluten, occurring in people with genetic predisposition. The course of the disease can vary and includes both intestinal and extra-intestinal manifestations. Many patients are undiagnosed for many years and some of them, in particular with nonspecific symptoms or asymptomatic, might never be diagnosed. We present a rare case of a patient, who's first and practically the only symptom of the disease was a pathological fracture of the ribs. In addition, despite the lack of clinical symptoms of malabsorption syndrome, malnutrition and proteinuria, we observed profound hypoalbuminemia and hypoproteinemia. This case suggests that CD diagnostic should be undertaken in evaluation of every patient with osteoporotic fractures and hypoalbuminemia.