Background: Leclercia adecarboxylata is a Gram-negative bacillus that can rarely cause infections in humans. We recently treated a case of peritonitis due to L. adecarboxylata in a peritoneal dialysis (PD) pediatric patient, and we systematically reviewed all the relevant reported cases in the literature. Methods: We searched the PubMed and Scopus databases, and we reviewed 13 such cases (2 children, 11 adults) that were reported, including our patient. Results: The mean (±SE) age was 53.2 ± 22.5 years, with a male-to-female ratio of approximately 1:1.6. Their mean vintage period on PD prior to L. adecarboxylata peritonitis was 37.5 ± 25.3 months. The VITEK card was the identification diagnostic tool in most cases (63%). The antimicrobial agent that was most frequently used was ceftazidime, which was implemented in 50% of cases as initial therapy, either as a monotherapy or combination therapy; in only two patients (15.3%) was the Tenkhoff catheter removed. The median duration of treatment was 18 days (range of 10–21 days), and all 13 patients that were reviewed were healed. Conclusions: Physicians should be aware that L. adecarboxylata is noted to rarely cause peritonitis in PD patients; however, this pathogen seems to be sensitive to most antimicrobial agents and can result in a favorable outcome with the selection of appropriate treatment.

Background/Objectives: Preterm birth interrupts nephrogenesis during a critical developmental window, resulting in reduced nephron endowment and lifelong renal vulnerability. Evidence indicates that individuals born preterm are at increased risk for hypertension, albuminuria, and chronic kidney disease (CKD) across the life course. This review synthesizes current evidence linking prematurity with adverse renal outcomes, explores key pathophysiological mechanisms, and discusses emerging biomarkers together with therapeutic strategies. Methods: This comprehensive review integrates evidence from clinical cohort studies, population-based registries, meta-analyses and experimental models. Factors such as neonatal acute kidney injury (AKI), nephrotoxic exposures and cardiometabolic interactions were integrated to provide a life-course perspective. Results: Preterm birth leads to reduced nephron endowment, compensatory glomerular hypertrophy, and hyperfiltration, which predispose to progressive nephron loss. Postnatal factors, including neonatal AKI, inflammation, nephrotoxic medications, and later cardiometabolic stress, act as cumulative “hits”, accelerating renal injury trajectories. Clinical studies demonstrate a higher prevalence of reduced estimated glomerular filtration rate, albuminuria, elevated blood pressure, and smaller kidney volumes from childhood into adulthood. Emerging biomarkers such as cystatin C, alongside imaging-based estimates of nephron endowment, may enhance early risk stratification. Conclusions: Preterm birth represents an independent, lifelong risk factor for CKD through combined developmental and postnatal mechanisms. Structured long-term surveillance and early preventive strategies are essential to preserve renal reserve in this population. Advances in biomarker-guided monitoring and targeted interventions may enable earlier identification of high-risk individuals and support precision approaches to nephroprotection after prematurity.

Background/Objectives: Furosemide is frequently used in preterm neonates for respiratory and fluid management but has been linked to nephrocalcinosis (NC), a renal complication with unclear long-term impact. Clarifying this association is crucial for safe diuretic use. Methods: A focused literature review included observational studies published between 1982 and 2025 reporting NC incidence by renal ultrasound in preterm infants receiving furosemide. Data on sample size, gestational age, birth weight, NC prevalence, and furosemide dosing/duration were extracted. Results were synthesized descriptively. Results: Twenty-two studies with 1489 infants were included. NC prevalence ranged 6–83%, higher in infants <32 weeks’ gestation or <1500 g. Across studies, incidence clustered at 17–41% between 4 weeks and term-equivalent age. Cumulative furosemide doses were generally three- to fourfold higher in NC groups (10–19 mg/kg cumulative vs. ≤5 mg/kg cumulative, p < 0.001). A dose-dependent risk was noted, with odds ratios increasing above a cumulative dose of 10 mg/kg. Some studies found no significant dose–response, indicating variability and confounding factors. NC was detected during NICU stay or around term-equivalent age; ~60% resolved after discontinuation, while persistent cases were associated with prolonged exposure and renal dysfunction. A recent multicenter, dose-escalation randomized trial showed that carefully dosed furosemide (≤2 mg/kg/day for 28 days) did not increase NC risk, though electrolyte disturbances were more frequent. Conclusions: Evidence supports a dose-related association between furosemide and NC in preterm infants. When administered cautiously within defined limits, risk may be mitigated. Careful dosing, monitoring, and further studies are essential for safe use.

Background/Objectives: Fungal peritonitis is a severe complication of peritoneal dialysis (PD) associated with catheter removal, technique failure, and increased mortality. Although Candida albicans was traditionally the predominant pathogen, non-albicans Candida (NAC) species are increasingly reported. This review summarizes the epidemiology and outcomes of PD-associated NAC peritonitis. Methods: A systematic review was performed following PRISMA guidelines. PubMed/MEDLINE, Scopus, and Google Scholar were searched (January 1990–March 2026) for NAC peritonitis studies. Case reports and series with species-level identification were included. Results: 31 studies met the inclusion criteria, comprising 25 individual case reports and 6 case series, totaling 89 NAC isolates. Candida parapsilosis was the most frequently reported species (n = 50), followed by Candida tropicalis (n = 15). Other pathogens included Candida glabrata, Candida guilliermondii, and several rare NAC species. Fluconazole was the most commonly used initial antifungal therapy. Catheter removal was performed in most cases, with the majority of patients requiring transition to hemodialysis. Overall mortality was 20% among individual case reports vs. 24% across case series. Species-specific differences were observed: C. parapsilosis and C. guilliermondii were generally associated with favorable outcomes, whereas infections involving C. glabrata and other emerging NAC species more frequently required treatment escalation and were linked to poorer outcomes. Conclusions: NAC species are an important cause of fungal peritonitis in PD patients and show considerable heterogeneity in clinical outcomes and antifungal susceptibility. Early species-level identification and prompt catheter removal remain essential for optimal management.

Peritoneal dialysis (PD)-related infections caused by rare pathogens are heterogeneous and clinically challenging, and available evidence is largely limited to isolated reports that hinder comparative interpretation. We conducted a controlled pooled narrative synthesis with exploratory comparative analyses of previously published, author-derived literature, designed to compare clinical outcomes across rare pathogen groups using a consistent analytical framework rather than a systematic review or meta-analysis. Infectious episodes were categorized into four groups: Gram-positive bacteria, Gram-negative bacteria, nontuberculous Mycobacteria (NTM) and fungal pathogens (Aspergillus spp.). Primary outcomes were catheter removal and infection-related mortality, while secondary outcomes were analyzed descriptively. In total, 135 infectious episodes were included (17 Gram-positive, 39 Gram-negative, 25 NTM and 55 Aspergillus). Catheter removal occurred in 11.8% of Gram-positive, 12.8% of Gram-negative, 95.8% of NTM and 85.5% of Aspergillus infections, while infection-related mortality was observed only in NTM (4.0%) and Aspergillus infections (38.2%). Exploratory comparisons suggested a gradient of severity across pathogen categories. In conclusion, rare PD pathogens show distinct, pathogen-specific outcome patterns. Rather than a validated prognostic model, we propose descriptive, hypothesis-generating pathogen-based severity tiers that may support early risk appraisal, guide timely decisions regarding catheter salvage versus early removal, and facilitate more tailored, pathogen-informed management in high-risk infections.