Essential hypertension is a leading cause of chronic kidney disease (CKD) and is frequently complicated by hypertensive nephropathy, characterized by nephroangiosclerosis and increased intrarenal vascular resistance, assessable by renal resistive index (RRI). Oxidative stress and endothelial dysfunction contribute to CKD progression, and the Mediterranean diet (MD) has been associated with a more favorable oxidative and endothelial profile, although data linking diet to renal microcirculation in hypertensive nephropathy remain limited. The aim of this study is to evaluate the relationship between RRI, oxidative stress, endothelial function, and adherence to the Mediterranean diet in patients with essential hypertension and hypertensive nephropathy. We performed a cross-sectional single-center study and we enrolled 99 patients with essential hypertension, hypertensive nephropathy, and CKD stages G1–G4 (KDIGO). All patients underwent laboratory testing, measurement of oxidative stress markers (sNOX2-dp, H₂O₂) and endothelial function (NO), renal ultrasound with interlobar RRI assessment, and PREDIMED questionnaire for MD adherence. A significant direct correlation was observed between RRI and oxidative stress markers (sNOX2-dp and H₂O₂) (p = 0.002, r = 0.302; p = 0.002, r = 0.322), while a significant inverse correlation was found between RRI and the endothelial function marker (NO) (p = 0.013, r = −0.302). The correlation between RRI and PREDIMED questionnaire scores did not reach statistical significance, but there was a trend toward an inverse association (p = 0.06, r = −0.18). In addition, a significant inverse correlation was observed between RRI and eGFR (p = 0.005, r = −0.27), consistent with published data. We also found a significant inverse correlation between sNOX2-dp and PREDIMED scores (p = 0.034, r = −0.21); no statistically significant correlations with H₂O₂ and NO were observed in this analysis. Higher intrarenal vascular resistance is associated with heightened oxidative stress, impaired endothelial function, and lower eGFR. Adherence to the Mediterranean diet is linked to lower NOX2-mediated oxidative stress, supporting a potential association between higher MD adherence and lower NOX2-related oxidative stress. These findings are hypothesis-generating and require confirmation in adequately powered longitudinal and interventional studies before any clinical inference on CKD progression can be made.

Acute kidney injury (AKI) is a systemic syndrome capable of inducing remote organ dysfunction. Kidney–lung crosstalk is a form of interorgan communication in acute nephrology, with the heart acting as a pivotal intermediary. Emerging evidence supports the involvement of a gut–lung–kidney axis. Complement activation in these multiorgan crosstalk has emerged as a central amplifier of multiorgan damage. We reviewed the literature on kidney–lung interactions and complement activation in AKI through a bibliographic search of PubMed, Scopus, and Web of Science. Most available data derive from experimental studies or intensive care unit (ICU) populations, often reported in reviews. We further report our real-world experience in a non-ICU nephrology setting, including 186 consecutive patients with AKI. Pulmonary involvement was present at hospital admission in 118 patients (63%). AKI stage 1 was observed in 20/118 patients (17%) with pulmonary involvement compared with 18/68 patients (27%) without pulmonary involvement (p < 0.001). In conclusion, AKI should be regarded as a systemic disease from its earliest stages. Kidney–lung interactions are clinically relevant even in mild AKI and outside critical care settings, underscoring the need for integrated organ assessment in routine nephrology practice. This review integrates complement activation as a central amplifier of kidney–lung crosstalk and multiorgan dysfunction, bridging experimental evidence with real-world observations from a non-critical care AKI population. By focusing on early AKI stages and the timing of pulmonary involvement, we highlight AKI as an active driver of systemic organ interactions rather than a late consequence of critical illness.

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder marked by progressive kidney enlargement and cyst formation, often resulting in end-stage renal disease (ESRD). Oxidative stress (OxS) significantly contributes to renal damage in chronic kidney disease (CKD) and ADPKD. While the Mediterranean diet (Med-diet) is known for its antioxidative and anti-inflammatory effects, its impact on OxS in ADPKD remains unclear. This study aimed to assess the relationship between adherence to the Med-diet, OxS levels, and renal function in ADPKD patients. We enrolled 63 ADPKD patients aged 18–70 years with CKD stages G2–G4. Adherence to the Med-diet was evaluated using the PREDIMED questionnaire. OxS markers (NOX2-derived peptide [sNOX2-dp] and hydrogen peroxide [H₂O₂]) were measured via ELISA. Correlations between these markers, Med-diet adherence, serum creatinine, and estimated glomerular filtration rate (eGFR) were analyzed. Higher adherence to the Med-diet was associated with significantly lower OxS markers (sNOX2, p < 0.001; H₂O₂, p = 0.04). Reduced NOX2 and H₂O₂ levels correlated with lower creatinine and higher eGFR (NOX2, p < 0.001; H₂O₂, p < 0.001), suggesting an inverse relationship between OxS and renal function. In conclusion, adherence to the Mediterranean diet appears to be associated with lower levels of oxidative stress and may slow the progression of chronic kidney disease. These findings suggest that dietary interventions could mitigate disease progression by modulating OxS. Further studies are needed to confirm these results and explore the long-term effects of the Med-diet on disease progression.

Introduction: the COVID-19 pandemic has brought to light the intricate interplay between viral infections and preexisting health conditions. In the field of kidney diseases, patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) and Chronic Kidney Disease (CKD) face unique challenges when exposed to the SARS-CoV-2 virus. This study aims to evaluate whether SARS-CoV-2 virus infection impacts renal function differently in patients suffering from ADPKD and CKD when compared to patients suffering only from CKD. Materials and methods: clinical data from 103 patients were collected and retrospectively analyzed. We compared the renal function of ADPKD and CKD patients at two distinct time points: before COVID-19 infection (T0) and 1 year after the infection (T1). We studied also a subpopulation of 37 patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min and affected by ADPKD and CKD. Results: clinical data were obtained from 59 (57.3%) ADPKD patients and 44 (42.7%) CKD patients. At T1, ADPKD patients had significantly higher serum creatinine levels compared to CKD patients, and a significantly lower eGFR was observed only in ADPKD patients with eGFR < 60 mL/min compared to CKD patients (p < 0.01, p < 0.05; respectively). Following COVID-19 infection, ADPKD–CKD patients exhibited significantly higher variation in both median serum creatinine (p < 0.001) and median eGFR (p < 0.001) compared to CKD patients. Conclusion: the interplay between COVID-19 and kidney disease is complex. In CKD patients, the relationship between COVID-19 and kidney disease progression is more established, while limited studies exist on the specific impact of COVID-19 on ADPKD patients. Current evidence does not suggest that ADPKD patients are at a higher risk of SARS-CoV-2 infection; however, in our study we showed a significant worsening of the renal function among ADPKD patients, particularly those with an eGFR < 60 mL/min, in comparison to patients with only CKD after a one-year follow-up from COVID-19 infection.

Background: Onconephrology is an emerging field addressing renal and cardiovascular complications in patients with cancer. Kidney disease and cardiovascular risk frequently coexist and may significantly affect oncological outcomes. Methods: We conducted a single-center, prospective, observational study including adult oncological patients. Patients were evaluated at baseline and after 1, 3, and 12 months. Renal outcomes (Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), AKI on CKD, Acute Kidney Disease (AKD)), cardiovascular risk assessment scores (using the SCORE/SCORE2 systems), and major adverse kidney events (MAKEs) were recorded. Results: Eighty-three patients were enrolled (mean age 69.8 ± 11.6 years, 60.2% male). At baseline, AKI was present in 30.4%, CKD in 27.8%, and AKI on CKD in 16.5% of patients. Overall, 96.7% of the cohort was classified as having a high or very high cardiovascular risk. During follow-up, 18.1% experienced new AKI, and MAKEs occurred in 30.4% of patients, driven primarily by mortality. Male sex emerged as the main predictor of death. Conclusions: Onconephrology patients suffer from a high burden of renal disease and cardiovascular risk. Integrated nephrological and cardiovascular assessment may represent a key component of personalized cancer care.

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by progressive kidney enlargement by cyst formation. Endothelial dysfunction significantly contributes to chronic kidney disease (CKD). The Mediterranean diet (Med-diet) may reduce endothelial dysfunction in ADPKD patients, but its effect was not investigated in these patients. Our aim was to assess the relationship between Med-diet adherence and endothelial function biomarkers such as nitric oxide (NO) and endothelin-1 (ET-1). We enrolled ADPKD patients aged 18–70 years with CKD stages G2–G4. Adherence to the Med-diet was evaluated using the PREDIMED questionnaire. NO and ET-1 were evaluated at enrolment. Correlations and associations between these markers and Med-diet adherence were analysed. We enrolled 63 patients with ADPKD (mean age was 50.0 ± 11.8 years, 66.7% were female). A low/intermediate adherence to Med-Diet was assessed in 47 (74.6%) patients. When comparing patients with low/intermediate and high adherence, we found a higher NO and lower ET-1 serum concentration (p < 0.001 and p = 0.014, respectively) in patients with high adherence compared with low/intermediate ones. We found a significant correlation between Med-Diet adherence and NO (Spearman’s rs = 0.696, p < 0.001, 95%CI 0.542 to 0.805) and ET-1 serum concentrations (rs = −0.387, p = 0.002, 95%CI −0.579 to −0.154). For the univariable and multivariable linear regression analyses, we found an association between Med-Diet and NO (B: 0.547, 95%CI 0.050 to 0.121, p < 0.001) between Med-Diet and ET-1 (B: −0.327, 95%CI −0.157 to −0.020, p = 0.012). In conclusion, higher Med-Diet adherence seems to be associated with more favourable endothelial function in ADPKD patients.