The relationship between chronic kidney disease (CKD) and renal cell carcinoma (RCC) is both bidirectional and multifactorial. Several risk factors, including hypertension, diabetes mellitus, obesity, and smoking, have been associated with an increased risk for the development of CKD and RCC. CKD may predispose individuals to RCC through various mechanisms, including renal cystic diseases or induced oxidative stress effects. Conversely, RCC can induce CKD through the direct effects of the tumor, after surgeries for the management of the tumor (either partial or radical nephrectomy), and through perioperative acute kidney injury. Furthermore, medical interventions, including immunotherapy or targeted therapies, may precipitate acute kidney injury, potentially leading to the development of CKD. The expression of several genes in renal tissues has been related to the remodeling of kidneys during end-stage kidney disease and with an increased risk of the development of preneoplastic lesions and tumors. The aim of this review is to update the knowledge of these relationships, highlight the pathophysiologic mechanisms, and identify the genes and molecular expressions involved in this pathway.

Background: Only a few published cases of primary adenocarcinoma of the upper urinary tract have been described in the literature. The aim of this systematic review was to collect all published cases of primary adenocarcinoma of the upper UT and identify prognostic factors and useful diagnostic modalities for their optimal treatment. Methods: Systematic research in the PubMed/Medline and Scopus databases concerning primary adenocarcinoma of the upper urinary tract was performed by two independent investigators. A total of 85 studies were included in the review. Results: In total, 84 patients were included, consisting of 54 males (64.29%) and 30 females (35.71%). Out of the available data, 24.71% reported a history of lithiasis, 16.47% episodes of pyelonephritis and 10.59% a history of hydronephrosis. Concerning histologic findings on excised tumors, 52.44% of neoplasms were mucinous, 19.51% tubulovilous, 18.29% papillary, 4.88% mixed mucinous–papillary and 4.88% poorly differentiated. Concerning anatomical origin, 62.34% of tumors were found in the renal pelvis, 22.08% in the ureter and 12.99% in both the renal pelvis and the ureter. Surgical treatment was the preferred therapeutic option and was performed in 96.39% of the included patients. In multivariable analysis, a statistically significant relationship was found between a clinical cure and ureter origin of the lesion (OR: 0.17, 95% CI: 0.00–0.22, p = 0.002), the presence of an abdominal mass (OR: 0.08, 95% CI: 0.01–0.63, p: 0.034) and a poorly differentiated histological type (OR: 0.02, 95% CI: 0.00–0.91). In multivariable time-to-event analysis, the male sex (HR: 0.12, 95% CI: 0.02–1.01, p: 0.019) and poorly differentiated histological type (HR: 91.06, 95% CI: 7.31–1134.32, p: 0.002) had statistically significant impacts on overall survival. Conclusions: Selection of the optimal surgical management, via either nephrectomy or nephroureterectomy, depends on the origin of the primary lesion and represents the mainstay of treatment. A suspicion from the urologist is needed for the identification and optimal treatment of these rare tumors.

Background: Urinary tract obstruction can lead to severe renal impairment if not managed effectively. Nephrostomy placement is a critical intervention to relieve such obstructions. The aim of this study was to compare the mono J single-step nephrostomy and the two-step balloon nephrostomy techniques in terms of procedural efficiency, patient tolerability, and complication rates. Methods: A prospective randomized observational design was employed, including patients requiring nephrostomy placement due to oncological conditions, urinary tract lithiasis, or functional disorders. Patients were randomized into two groups based on the different method of nephrostomy tube placement: one with the mono J single-step method and the other with the two-step balloon method. The primary outcomes were to compare the average placement time, the accuracy of the tube placement between methods, and reported complications at 3, 6, 9, and 12 months, verified through immediate post-procedural imaging. Secondary outcomes evaluated post-procedure pain levels were using the visual analogue scale (VAS) between the two methods. Results: The mono J single-step method had a significantly shorter average placement time (Mann–Whitney, W = 367.5, p = 0.006), while the two-step method demonstrated better early tube stability, as evidenced by fewer dislocations at 3 months (Chi-square, χ²(1) = 4.828, p = 0.028, Cramer’s V = 0.28) and 6 months (Chi-square, χ²(1) = 5.198, p = 0.023, Cramer’s V = 0.29). No significant differences between methods were recorded at 6 and 12 months. Patient tolerability was comparable between the two methods, and no significant difference was reported. Conclusions: Although the mono J single-step technique is more time-efficient, the two-step balloon method offers advantages in early tube stability, providing valuable insights for optimizing clinical decision-making in nephrostomy placement.

Actinomycosis of the kidney is extremely rare, with only a few cases reported in the literature. This rare entity usually presents with common clinical manifestations and non-specific imaging findings, thus rendering its diagnosis extremely challenging. According to case reports published in the literature, fever was present in the majority of cases (56.25%). Several risk factors have been related to the development of renal actinomycosis, including a history of urogenital surgery, urolithiasis, or urogenital cancer. Initial diagnostic investigation consists of abdominal ultrasonography (15 patients, 46.88%) and abdominal computed tomography (23 patients, 48.15%). Regarding therapeutic approach, 5 patients (16.67%) received only antibiotic treatment, 5 patients (16.67%) underwent surgery, and 20 patients (66.67%) received both antibiotic and surgical treatment. Accurate diagnosis relies on the clinician’s high index of suspicion and is ultimately confirmed through histological examination or cultures, obtained either preoperatively via biopsies or postoperatively after surgical removal of the infected kidney. To our knowledge, this is the first narrative review of the literature that collects knowledge concerning infection of UUT induced by dysbiosis of actinomycosis species. The aim of this narrative review was to systematically search the literature on primary renal actinomycosis, highlighting the diagnostic approach and treatment strategies for the management of this rare entity.