Introduction: Emphysematous pyelonephritis is a rare but potentially life-threatening urinary tract infection characterized by the formation of gas in the renal parenchyma, collecting system, and perinephric tissue. The condition typically develops in patients with specific predisposing factors such as diabetes mellitus, congenital or acquired obstructive uropathies, or individuals taking immunosuppressive agents. Rarely can the disease occur in patients with other predisposing factors, such as the use of SGLT2 inhibitors, but this is quite uncommon. The incidence of urinary tract infections associated with their use is still debatable, but cases of emphysematous pyelonephritis associated with SGLT2 inhibitors have been described in medical literature. Case Presentation: We present a rare case of a patient with emphysematous pyelonephritis without classical risk factors for the disease, who was taking an SGLT2 inhibitor. Conclusion: Although the frequency of urinary tract infections following the use of SGLT2 inhibitors is relatively low, their widespread application for treatment of numerous socially significant diseases underscores the necessity for specialists to be aware with all potential risks associated with their use, including the development of severe urinary tract infections.

Background and Clinical Significance: Spontaneous renal hematoma, also known as Wunderlich syndrome (WS), is a rare disease characterized by the acute onset of spontaneous renal hemorrhage into the subcapsular, perirenal, and/or pararenal spaces without a history of prior trauma. WS can be a life-threatening condition due to hemorrhagic shock; consequently, prompt diagnosis and a therapeutic approach are essential for favorable outcomes. Treatment ranges from conservative management to surgical intervention. The most common etiologies are neoplasms and vascular diseases, but WS can also be observed in patients undergoing hemodialysis. In patients with end-stage renal disease (ESRD), especially those on hemodialysis, acquired cystic kidney disease and renal cell carcinoma are among the primary causes of WS. Although less common, WS can develop in dialysis patients even in the absence of traditional (primary) risk factors. In general, patients with chronic kidney disease (CKD) have a paradoxical hemostatic profile, likely explaining their higher tendency to bleed, so WS can occur without existing predisposing factors. The multifactorial pathogenesis in these patients includes functional platelet abnormalities, intimal arterial fibrosis, chronic inflammation, and oxidative stress associated with ESRD. The use of hemodialysis-related antithrombotic medications could serve as another contributing factor increasing the risk of bleeding. C ase Presentation: We present a case report of a 62-year-old male on chronic dialysis who developed sudden right-sided lumbar pain and hematuria during dialysis without evidence of prior trauma. Imaging revealed a large subcapsular hematoma of the right kidney. Further investigations did not reveal additional risk factors in this instance; however, his routinely used hemodialysis-related antithrombotic medications were potentially a contributing factor. Despite conservative treatment, his condition worsened, and the hematoma enlarged, requiring emergency nephrectomy. Postoperatively, his condition gradually improved. Conclusions: This case highlights the importance of considering WS in hemodialysis patients, even without the presence of traditional risk factors, as well as including WS in the differential diagnosis of acute abdominal pain.

Background and Objectives: Hyperphosphatemia is a key component of chronic kidney disease-mineral and bone disorder and is associated with higher rates of cardiovascular events and mortality in patients undergoing dialysis. Phosphate binders are essential for phosphorus reduction, and their evaluation relies on several factors, such as chemical composition, binding capacity, and safety profile. Unfortunately, long-term management is hindered by high pill burden and poor adherence. Magnesium phosphate binders have proven effectiveness in reducing phosphate levels. Nevertheless, despite their efficacy, they are not widely used in clinical settings because of concerns related to their use. This study assessed the efficacy of low-dose magnesium carbonate as a phosphate binder in patients undergoing chronic dialysis, focusing on its biochemical control, tolerability, and cost-effectiveness. Materials and Methods: A prospective observational study was conducted on 54 hemodialysis patients with end-stage renal disease at a single dialysis center. Patients were taking either 250 mg magnesium carbonate or 2400 mg sevelamer carbonate for 3 months. Results: Both groups showed decreased phosphorus levels, with a 14.2% significant reduction in the magnesium carbonate group (p < 0.001) and a 5.1% reduction in the sevelamer carbonate group. At the end of the study, no significant differences were observed between the groups (p = 0.682). In the magnesium carbonate group at month 3, compared to baseline, no significant differences were detected in other laboratory parameters reflecting calcium–phosphorus metabolism (Ca—p = 0.681, PTH—p = 0.126). Simultaneously, good compliance without clinically relevant gastrointestinal side effects was observed, including the absence of clinically significant hypermagnesemia. Conclusions: The phosphorus-lowering potential of low-dose magnesium carbonate is non-inferior to that of low-dose sevelamer carbonate. However, its favorable safety profile, low incidence of adverse effects, and cost-effectiveness make it a promising option in clinical practice, further highlighting the need for better recognition by physicians.

Background and Clinical Significance: Spontaneous renal hematoma, also known as Wunderlich Syndrome (WS) is a rare disease, characterized by the acute onset of spontaneous renal hemorrhage into the subcapsular, perirenal, and/or pararenal spaces, without a history of prior trauma. It can be a life-threatening condition due to hemorrhagic shock, consequently, prompt diagnosis and therapeutic approach are essential for favorable outcomes. Treatment ranges from conservative management to surgical intervention. The most common etiologies are neoplasms, vascular diseases but it can be also observed in patients undergoing hemodialysis, especially those with acquired cystic kidney disease or renal cell carcinoma. However, patients with CKD, on particular those on dialysis, have a paradoxical hemostatic potential with increased rates of bleeding, so WS may occur even without the so-called common risk factors. The multifactorial pathogenesis in these patients includes specific coagulation abnormalities and the impaired architectonics of the renal tissue, as well as the use of antithrombotic agents. Case Presentation: We present a case report of a 62-year-old male on chronic dialysis who developed a sudden right-sided lumbar pain and hematuria during dialysis without evidence of prior trauma. Imaging revealed a large subcapsular hematoma of the right kidney. Despite conservative treatment, his condition worsened and the hematoma enlarged, requiring emergency nephrectomy. Pathology confirmed extensive hemorrhage in a nephrosclerotic kidney. Postoperatively, his condition gradually improved. Conclusions: This case highlights the importance of considering WS in hemodialysis patients, and should be included in differential diagnosis of acute abdominal pain.