Chronic kidney disease (CKD) is a progressive condition that affects more than 10% of the population worldwide, accounting for more than 843 million (M) individuals. The prevalence of CKD (844 M patients) is higher than that of diabetes mellitus (422 M patients), cancer (42 M patients), and HIV (37 M patients), but people are often less aware of it. Global expert groups predict reductions in the nephrology workforce in the next decade, with a declining interest in nephrology careers. Over time, KDIGO guidelines have also focused on topics related to the prevention or management of CKD patients in real-life settings. On these premises, a new educational program with international experts in the field of nephrology took place from November 2022 until March 2023 in Milan, Italy. This multinational masterclass provided an educational platform providing unbiased education on diagnosis and treatment by sharing the most recent research data on CKD and comorbidities, therefore creating a snowball effect to increase the implementation of best practices worldwide, using examples from ‘real-life’ patient outcomes. This paper provides an overview of the International Nephrology Masterclass (INM) concept, summarizing the key lectures and discussions, and giving an outline of future key developments.

Climate change significantly impacts natural environments, economies, and human health, with rising global temperatures causing increasingly frequent extreme weather events. Studies have shown that heat exposure accelerates kidney function decline and increases hospitalizations for renal diseases. Heat contributes to kidney disease through mechanisms such as dehydration, ischemic injury, inflammation, and oxidative stress, leading to acute kidney injury, chronic kidney disease, increased risk of kidney stone formation, and proteinuria. In light of the anticipated rise in temperatures in the forthcoming years, it is of crucial importance to know the possible consequences for kidney health. This review highlights the relationship between these phenomena, the potential complications that may arise, and the mechanisms of their occurrence. The identification of these mechanisms will further support the development of future targeted preventive strategies and interventions.

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.

Nephrotoxicity is a common complication during antineoplastic therapy, particularly when platinum-based medications are used. Early detection of this condition is crucial for improving risk stratification and management, thereby enhancing decision-making in kidney disease treatment. However, traditional biomarkers for renal assessment lack sensitivity in identifying early or subclinical damage, underscoring the need for novel and more precise markers. This study aimed to investigate the effectiveness of urinary KIM-1, clusterin, nephrin, and serum cystatin C in detecting nephrotoxicity associated with platinum-based therapies. A total of 43 patients with different oncological diseases participated in the prospective study, divided into two groups based on the nephrotoxic potential of the administered drugs: patients treated with cisplatin (high-risk group for nephrotoxicity) and patients treated with oxaliplatin/carboplatin (low-to-moderate risk group for nephrotoxicity). The results showed that nephrotoxicity, determined as a decrease in eGFR of >10 mL/min/1.73 m² at the sixth month after initiation of platinum-based therapy, occurred in 54.3% of cases, with 80% of these attributable to cisplatin-based therapy. Conventional renal biomarkers, such as the serum creatinine and urine albumin-creatinine ratio, have shown controversial results in the course of the study. In contrast, the patients treated with cisplatin, as well as those who developed nephrotoxicity, showed significant increases in the mean values of cystatin C (p < 0.001, respectively, p < 0.001), urinary KIM-1 (p = 0.005, respectively, p = 0.002), and urinary clusterin (p = 0.001, respectively, p = 0.001). Among the group with a low to moderate risk of nephrotoxicity including those treated with oxaliplatin/carboplatin, no statistically significant changes over time were observed in any of the biomarkers. These findings suggest that the aforementioned biomarkers can be used for the early detection of cisplatin-induced eGFR decline.

Rhabdomyolysis (RM) is characterised by the breakdown of skeletal muscle tissue, releasing toxic intracellular components into circulation. It presents with dark urine, muscle weakness, myalgia, and elevated creatine phosphokinase levels (CPK). Drug-induced RM is aetiologically significant. This case report describes a 25-year-old male who developed severe RM and Acute Kidney Injury (AKI) after intramuscular (IM) heroin administration as a first time user. IM heroin use can induce higher CPK levels due to direct myocyte toxicity and mechanical trauma. The highly vascularised gluteal muscles with type 1 fibres at the injection site likely exacerbated the severity. Additional factors included lower mitochondrial density in males and alcohol exposure. Despite aggressive fluid resuscitation, renal replacement therapy (RRT) was required, and the patient responded well to haemodialysis. This case highlights AKI as a severe complication of IM heroin use, underscoring the need for further research into drug-induced RM.