The use of extracorporeal membrane oxygenation (ECMO) has expanded for severe respiratory and circulatory failure. Acute kidney injury (AKI) is one of the

Background and Objectives: Cardiovascular disease is the leading cause of mortality in patients with ANCA-associated vasculitis (AAV) after the first year post-diagnosis. This study investigated relationships between traditional risk factors, echocardiographic findings, disease activity, and major adverse cardiovascular events (MACE) in AAV patients. Aim: This retrospective single-center study aimed to evaluate the impact of traditional cardiovascular risk factors and echocardiographic parameters on the occurrence of MACE in patients with AAV. Materials and Methods: This study included adult patients with AAV who were evaluated between 2020 and 2025. Data collected included demographics, cardiovascular risk factors, Birmingham Vasculitis Activity Score version 3 (BVASv3), laboratory parameters, immunosuppressive therapy, and transthoracic echocardiography (TTE) findings. MACE was defined as myocardial infarction, stroke, revascularization, cardiovascular hospitalization, or cardiovascular death. Results: The cohort comprised 32 females (61.5%) and 20 males (38.5%), with a mean age of 62.4 ± 12.4 years. MACE occurred in 38.5% of patients. Male gender (p = 0.002), overweight (p = 0.016), hyperlipidemia (p = 0.003), and prior cardiovascular disease (p = 0.002) were significantly associated with MACE in univariate analyses. Patients with MACE had larger left atrial anteroposterior dimensions on the parasternal long-axis view (median 3.9 vs. 3.3 cm, p = 0.002) and lower left ventricular ejection fraction assessed by the modified biplane Simpson’s method (median 53% vs. 60%, p = 0.002). Valvular dysfunction was not associated with MACE in a statistically significant manner. Disease activity markers (BVASv3 and CRP) showed no significant correlation with cardiovascular events or echocardiographic parameters. Conclusions: Our results demonstrate that traditional cardiovascular risk factors are stronger determinants of MACE in AAV patients than disease-specific parameters. Cardiac structural changes, including left atrial dilation and decreased left ventricular ejection fraction, were significantly associated with cardiovascular outcomes. These findings underscore the importance of integrating systematic cardiovascular risk assessment and aggressive risk factor modification into standard AAV management protocols.

Background and Aims: Cognitive impairment (CI) and depression are frequent comorbidities in chronic hemodialysis (HD) patients with substantial impact on health-related quality of life (HRQoL). This study examined their prevalence, predictors, and independent associations with HRQoL. Methods: A cross-sectional study enrolled 70 adult maintenance HD patients. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA); depressive symptoms with the Beck Depression Inventory (BDI); and HRQoL with the Kidney Disease Quality of Life instrument (KDQOL-SF). Logistic regression, multiple linear regression, and mediation analysis were applied. Results: CI (MoCA ≤ 24) was present in 54.3% of patients; clinically significant depressive symptoms (BDI ≥ 14) were present in 44.4%. BDI was not correlated with MoCA (p = 0.656) or MMSE (p = 0.880), confirming independence of the two dimensions in cross-section. Older age (OR = 1.106, p = 0.001) and male sex (OR = 4.523, p = 0.022) were independent predictors of CI. BDI significantly correlated with 15 of 19 KDQOL domains and was the dominant predictor across 10 domains in multiple linear regression (Adj. R² up to 0.358). MoCA correlated with only two KDQOL domains. Mediation analysis confirmed that MoCA does not mediate the BDI–HRQoL relationship (indirect effect: −0.004, 95% bootstrap CI: −0.106 to +0.097). Conclusions: CI and depression are highly prevalent and clinically distinct dimensions in HD patients, though subtle longitudinal interactions cannot be excluded. Depression is the dominant determinant of impaired HRQoL, acting through a direct, cognitively independent pathway, and represents the primary modifiable target for improving quality of life in this population.

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder primarily known for progressive kidney cysts, and it is the most common hereditary syndrome linked to intracranial aneurysms (IAs). Approximately 5–20% of ADPKD patients have IAs (versus ~3% in the general population). Key risk factors for IAs in ADPKD include a family history of aneurysmal subarachnoid hemorrhage (SAH), early-onset or poorly controlled hypertension, and possibly more severe kidney disease (e.g., large total kidney volume and reduced kidney function). The PKD1 and PKD2 mutations in ADPKD lead to polycystin-1/-2 dysfunction in vascular cells, causing intrinsic vessel wall weakness. This weakness—compounded by chronic hemodynamic stress and inflammation—predisposes ADPKD patients to aneurysm formation. Clinically, most aneurysms in ADPKD are small (<7 mm), asymptomatic, and located in the anterior cerebral circulation. Their growth and rupture risk appears similar to aneurysms in non-ADPKD patients; however, ruptures in ADPKD occur at younger ages, underscoring the need for vigilant management. This narrative review provides a nephrology-oriented overview of intracranial aneurysms in ADPKD, including pathophysiology, epidemiology, and clinical management. Key Messages: -ADPKD carries a higher prevalence of intracranial aneurysms (≈5–20%) than the general population (≈3%). Key risk factors include a family history of aneurysm/SAH, early or poorly controlled hypertension, and possibly advanced renal disease. -Guidelines support targeted rather than universal screening, mainly in patients with family history or prior SAH. -Non-contrast MRA is the preferred modality, usually initiated around age 30 in at-risk individuals. -Most aneurysms are small and asymptomatic; small lesions are monitored with BP control and imaging, while larger or high-risk aneurysms are treated prophylactically. -Broader screening remains debated. Future genetic insights may improve risk stratification, but current practice requires balancing rupture prevention against over screening.

Introduction/Objective. Kidney transplant recipients were at higher risk for COVID-19-associated complications and mortality. The goal was to examine the frequency and outcomes of COVID-19 infection among patients under our center's control, as well as the effects of tocilizumab and anti-SARS-CoV-2 antibodies. Methods. We analyzed a cohort of 220 kidney transplant patients monitored at our center who experienced COVID-19 infection between March 2020 and March 2022. Results. In the period of two years, 55 pts contracted COVID-19 (25%). The average age of the infected was 48.38 years old. In 24% of patients during COVID-19 infection the immunosuppressive therapy did not change. Because of pneumonia development 33% of patients have been hospitalized. Of all infected patients, tocilizumab was used in 7% of patients, of whom three died. AntiSARS-COV-2 mAb was used in 24% of patients, no fatalities were reported. Antivirotic (favipiravir) was used in 4% of patients, in one case fatal. CRRT/HD was applied in 5.5% of patients. Out of all infected, death occurred in 14.5% of patients. The cause of death was severe acute respiratory syndrome (50%), cardiac arrest (25%), or multiorgan failure (25%). All of these patients had serious comorbidities, or were late admitted to the transplant center. Conclusions. The therapeutic use of mAb was reliable, with a significant positive effect on achieving a milder clinical form and shorter duration of the disease. The main risk factors of adverse outcomes of COVID-19 infection in kidney transplant recipients were serious comorbidities and late admission to the transplant center.