This systematic review and meta-analysis evaluated complication rates and diagnostic yield reported in studies of adult native kidney biopsy using 16-gauge (16 G) or 18-gauge (18 G) needles. We included randomized trials and cohort studies of real-time ultrasound-guided biopsies, including case series. MEDLINE, Embase, and CENTRAL were searched through October 2024. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using Joanna Briggs Institute tools. Random-effects meta-analyses estimated pooled proportions with 95% confidence intervals (CI), and univariable random-effects meta-regression explored study-level associations with major complications, transfusion, or gross hematuria. We screened 4,499 titles and abstracts and reviewed 319 full-text articles; 62 studies comprising 68 biopsy series were included. The pooled major complication rate in studies using 16 G needles was 1.83% (95% CI: 1.20-2.79) and 1.29% (95% CI: 0.78-2.13) in studies using 18 G needles, with no statistically significant difference. Mean glomerular yield was 18.8 with 16 G and 17.5 with 18 G needles. In study-level meta-regression, studies with higher prevalence of acute kidney injury, lower mean estimated glomerular filtration rate, or lower mean hemoglobin reported higher pooled complication rates. Most studies were single-arm cohorts; between-needle differences therefore reflect indirect study-level contrasts. Interpretation is limited by retrospective design and heterogeneity across studies. Overall, studies using both needle sizes reported low complication rates and similar diagnostic yield, although definitions and reporting varied. Direct comparative studies are needed to determine whether meaningful differences exist.

Chemical exchange saturation transfer (CEST) MRI generates contrast by transferring saturation from exchangeable protons to bulk water. In diamagnetic agents, labile -NH/-OH protons typically resonate close to water (1-5 ppm), severely limiting selectivity. Thus, larger chemical shift offsets are highly desirable for in vivo applications. Efficient CEST at clinical field strengths also requires exchange rates within a narrow kinetic window. Tetraalkyl 1,8-diaminonaphthalenes (proton sponges) are attractive scaffolds for diaCEST agents because the labile proton locked in a strong hydrogen bond between the two nitrogens in the monoprotonated forms can exhibit extraordinarily large downfield chemical shift offsets from water. However, these compounds do not have CEST because the strong H-bond also results in very slow exchange with the bulk. Here, we report the design, synthesis, and evaluation of a new tetrasubstituted 1,8-diaminonaphthalene derivative in which proton exchange is accelerated by intramolecular catalysis. Detailed structural, thermodynamic, and kinetic studies of 1,8-diaminonaphthalene tetraacetic acid (DANTA) reveal that the carboxylate groups participate in intramolecular hydrogen-bonding interactions with the central N···H+···N bridge, markedly accelerating the proton exchange rate to 492 s-1 at 37 °C, which is within the optimal kinetic regime for CEST at 3 T. Importantly, the carboxylate substituents do not affect the chemical shift offset of the exchanging proton, which remains substantially deshielded and highly downfield shifted at 12.5 ppm from water. In vivo MRI studies further demonstrate that DANTA generates exquisite CEST contrast in the kidneys of mice at 3 T using clinically permissible saturation RF field strengths.

Hypertension is considered a major global health threat, which​ can lead to severe complications, including vascular remodeling, heart failure, myocardial infarction, and end-stage renal disease. Syrian golden hamsters, a model with naturally expressing cholesteryl ester transfer protein (CETP), are susceptible to diet-induced hyperlipidemia. To establish a reliable and reproducible hamster model for studying the relationship between renal artery stenosis (RAS), secondary hypertension, and cardiovascular disease, the two-kidney, one-clip (2K1C) Goldblatt model was employed. This study details a refined surgical procedure for inducing RAS in Syrian golden hamsters via partial renal artery ligation, emphasizing critical factors such as surgical isolation technique and ligature material selection, which significantly impact outcomes. Implementation of this standardized surgical protocol resulted in approximately 90% of treated hamsters exhibiting a consistent systolic blood pressure elevation of 25-30 mmHg. This optimized renal artery ligation procedure provides a robust method for generating a hypertensive hamster model with high consistency, enhanced reproducibility, and utility for cardiovascular disease research.

Digitizing large histopathology archives requires processing millions of scanned whole-slide images that must be validated rapidly. Automated organ-of-origin classification can accelerate quality control and enable early detection of mislabeled specimens. We developed a deep learning model that classifies the organ of origin from hematoxylin and eosin-stained slides using a single low-resolution thumbnail per slide in under 1 s. For training, we used thumbnails from 16,624 slides from The Cancer Genome Atlas (TCGA) and Clinical Proteomic Tumor Analysis Consortium (CPTAC) archives, which contain mostly primary tumor resections. The images were categorized into 14 classes based on the most common primary sites in TCGA: Bladder, Brain, Breast, Colorectal, Kidney, Liver, Lung, Pancreas, Prostate, Skin, Stomach, Thyroid gland, Uterus, and Other (encompassing the remaining tissue types). We evaluated our approach on two independent external cohorts: a 5-class cohort with 2857 slides (Colorectal, Kidney, Liver, Pancreas, and Prostate) and a comprehensive 14-class cohort (12,348 slides). The model achieved 90% balanced accuracy for the 5-class cohort and 62% for the full 14-class cohort. Notably, when considering only the predictions with high confidence, 53% of the large cohort could be classified with 74% balanced accuracy. Manual review of high-confidence misclassifications suggested that some may reflect errors in the ground truth rather than model error. Mean model inference time was 0.2 s per slide on an NVIDIA L4 GPU. Our deep learning approach demonstrates high classification performance with very low inference time, indicating its potential for real-time and cost-effective quality control in digital pathology.

Primary Sjögren's disease (pSjD) is a chronic systemic autoimmune disease in which immune-mediated pathology is not confined to exocrine glands but also affects multiple organ systems. Renal involvement constitutes a clinically meaningful manifestation of pSjD and may exert a considerable impact on disease progression, prognosis, and treatment selection. However, the pathogenic basis of renal injury in pSjD is still incompletely understood, and existing therapeutic approaches remain largely empirical. Available studies suggest that renal involvement in pSjD arises from the interaction of multiple determinants, including inherited susceptibility, environmental factors, and endocrine dysregulation. At the core of these pathogenic mechanisms lies persistent activation of the type I interferon (IFN-I) system and immune dysregulation driven by excessive responses of T and B lymphocytes. Such immune abnormalities favor sustained autoantibody production and ectopic germinal center (EGC) formation, thereby amplifying autoimmune inflammation and promoting renal structural and functional injury. Here, this review integrates relevant literature to examine the multifactorial pathogenic mechanisms described above and to systematically elucidate how these mechanisms drive autoimmune responses through diverse immune cell populations. In addition, the potential application prospects of relevant novel targeted therapeutic strategies in pSjD-related renal damage are discussed.

Current treatment of severe autoimmune glomerulonephritis such as lupus nephritis (LN) and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) relies primarily on immunosuppression to reduce kidney inflammation and chronic damage. However, many patients exhibit persistent proteinuria despite treatment, which serves as a prognostic biomarker for long-term outcomes. The residual proteinuria after 12 months might reflect hyperfiltration in remaining nephrons due to chronic damage rather than active inflammation, contributing to progressive kidney function deterioration.

Renal arteriovenous fistulae are rare vascular anomalies that can lead to hypertension, high-output heart failure, or renal dysfunction when associated with a large left-to-right shunt. Renal arteriovenous fistulae with dilatation of the inferior vena cava are particularly uncommon, and the optimal endovascular strategy remains controversial. This report describes the cases of 2 asymptomatic patients with incidentally detected right renal arteriovenous fistulae and dilatation of the inferior vena cava who were treated with balloon-assisted transarterial coil embolization of the shunt while preserving the normal renal arterial branches. In 1 patient, migration of a coil into the right atrium occurred after deflation of the balloon, but was successfully managed with endovascular retrieval and additional coil packing under renewed flow control. Four months after treatment, both patients showed durable angiographic occlusion of the fistula, a reduction in the diameter of the inferior vena cava, and preserved global renal function, although a limited perfusion defect was observed in the lower pole of the kidney in 1 patient. Balloon-assisted coil embolization may represent a valuable treatment option for high-flow renal arteriovenous fistulae with inferior vena cava dilatation when performed with meticulous flow control and careful coil selection.

Descending necrotizing mediastinitis is a rare, life-threatening extension of deep neck infection. We report the case of a 51-year-old woman who initially presented with a sore throat and was treated as uncomplicated pharyngitis before rapidly developing neck swelling, chest pain, dyspnea, septic shock, pneumomediastinum, and bilateral pleural empyemas. Combined cervicothoracic exploration showed dishwater fluid in the neck and mediastinum without esophageal perforation, and cultures grew Streptococcus anginosus and mixed oral flora with Actinomyces odontolyticus bacteremia. Her course was complicated by stress-induced cardiomyopathy, acute kidney injury requiring continuous renal replacement therapy, and vasopressor-associated digital ischemia. On hospital day 17, repeat exploration identified a large left hypopharyngeal pharyngocutaneous fistula communicating with the open neck wound. Because of critical illness and poor peripheral perfusion, flap reconstruction was deferred. The fistula was managed with repeated antiseptic packing, strict gastrostomy feeding, salivary suctioning, glycopyrrolate, scopolamine, and later botulinum toxin injections to the parotid and submandibular glands. The defect gradually contracted and closed by secondary intention over approximately 10 weeks. This case highlights that, in carefully selected high-risk patients, structured conservative management with salivary suppression may allow closure of a large pharyngocutaneous fistula after fulminant descending necrotizing mediastinitis.

Wunderlich syndrome (WS) is a critical urological emergency defined by spontaneous, non-traumatic renal hemorrhage into the subcapsular and perirenal spaces. While typically associated with renal neoplasms like angiomyolipoma or renal cell carcinoma, this report describes an uncommon presentation of WS secondary to acute pyelonephritis. This case highlights the diagnostic challenge of differentiating infectious etiologies from ruptured malignancies in the acute setting. A 50-year-old female patient with a history of long-standing rheumatoid arthritis presented with sudden-onset, severe left lumbar pain, nausea, and vomiting. Physical examination revealed a palpable left flank mass and tenderness. Laboratory studies were significant for neutrophilic leukocytosis (14,010 µL; 89% neutrophils) and abundant bacteriuria. An abdominal CT scan demonstrated a large (10 x 8.5 x 13.5 cm) hyperdense posterolateral collection within the left kidney with loss of normal renal morphology. Due to active hemorrhage and the intraoperative identification of multiple suspicious parenchymal nodules, an emergency total left nephrectomy was performed. Surprisingly, histopathological evaluation revealed no evidence of neoplasia, confirming a diagnosis of acute pyelonephritis with microabscess formation and associated subcapsular hematomas. The patient was stabilized postoperatively with blood transfusion and discharged in stable condition. Although WS is predominantly neoplasic in origin, acute infectious processes can precipitate catastrophic renal hemorrhage. This case underscores that emergency nephrectomy remains a justified, life-saving intervention when hemodynamic stability is compromised, or malignancy cannot be excluded, even in the presence of purely infectious triggers.

Cancer biomarkers are now recognized as major tools for early detection, diagnosis, and prognosis. In the last 10 years or so, molecular biology, proteomics, and genomics have been rapidly advancing to find tissue-specific biomarkers used in clinical practice. In this review, the development of the cancer biomarkers published in 2011-2025, for lung, breast, liver, and kidney cancers, is reviewed. A systematic review of peer-reviewed literature searched PubMed, Scopus, and Web of Science, including human and published English studies. A variety of detection approaches, including immunohistochemistry, next-generation sequencing, and liquid biopsy technology, were assessed with an explicit focus on clinically relevant biomarkers. The main trends indicate that while classic protein markers, particularly carcinoembryonic antigen and neuron-specific enolase in lung cancer, hormone receptor status and HER2 in breast cancer, and alpha-fetoprotein in liver cancer, have evolved, many modern genomic markers including epidermal growth factor receptor mutations, anaplastic lymphoma kinase rearrangements, TP53 mutations, vascular endothelial growth factor pathways, and von Hippel-Lindau gene alterations have evolved, resulting in a large gap in their knowledge. These innovations underscore the importance of molecular biomarkers in supporting early detection, targeted therapy, and enhanced surveillance of disease progression. Cancer biomarker studies have evolved from protein-based biomarkers to encompass both genomic and transcriptomic targets, which may allow for more targeted and individualized cancer interventions. Multi-omics integration and novel types of biomarkers like circulating tumor DNA, circulating tumor cells, and microRNAs will focus on developing early diagnosis, prognosis, and personalized treatment strategies as a prerequisite of such work.