Historically, the presence of stones in a donor kidney has been a contraindication to kidney use for transplantation. However, favorable experiences transplanting living donor kidneys with isolated stones as well as successful management of de novo stone formation following living or deceased donor kidney transplantation have provided insights regarding the benefits and risks of this strategy. The limited supply of available donor kidneys has led to a reexamination of donor selection criteria to meet demand. This reevaluation is also influenced by medical advancements that have allowed for the safe management of allograft kidney stones without compromising outcomes. Herein we report the accidental transplantation of a kidney with a large pre-existing calculus from an otherwise acceptable deceased donor. Based on literature review and given the benefits of kidney transplantation versus dialysis in the setting of prolonged waiting times, expansion of the donor pool to include kidneys with large or multiple stones may be a feasible option to improve utilization and access without necessarily compromising subsequent outcomes.

Keywords: Donor-Gifted Stone; Donor Selection; Kidney Nonuse; Percutaneous Nephrolithotomy; Urolithiasis

Abbreviations: CT: Computerized Tomography; eGFR: Estimated Glomerular Filtration Rate; KDPI: Kidney Donor Profile Index.

Introduction: Transplant renal artery stenosis (TRAS) is the most common vascular complication following kidney transplantation. Deceased donor kidneys exhibiting severe atherosclerosis involving the renal artery, if untreated, represent one cause of TRAS.

Methods: We report herein two cases of TRAS that occurred following back bench ex vivo eversion endarterectomy (EE) prior to deceased donor kidney transplantation (DDKT).

Results: Both patients presented in the first year following DDKT with worsening hypertension and one patient experienced acute kidney injury. Duplex ultrasonography was suspicious for markedly elevated renal artery velocities in the proximal to mid-renal artery segment with evidence for distal turbulence. Subsequent arteriography through an ipsilateral femoral approach confirmed severe TRAS that was successfully treated with balloon angioplasty and stenting. Both patients experienced improvements in blood pressure control, and one patient had resolution of acute kidney injury.

Conclusion: Ex vivo EE may be performed successfully as a rescue procedure to prevent nonuse of donor kidneys with severe intrinsic atherosclerosis. However, these patients may still be at risk for developing TRAS, possibly from a localized dissection occurring secondary to an intimal flap.

Keywords: Deceased Donor; Eversion Endarterectomy; Renal Atherosclerosis; Transplant Renal Artery Stenosis

Abbreviations: BMI: Body mass index; DDKT: Deceased donor kidney transplant; EE: Eversion endarterectomy; GFR: Glomerular filtration rate; KDPI: Kidney donor profile index; TRAS: Transplant renal artery stenosis.

Background: Ketamine use is increasingly associated with lower urinary tract symptoms, including ketamine-induced uropathy (KIU). Characterising affected patients and treatment outcomes is essential to guide management.

Method: A cross-sectional study included 20 patients diagnosed with KIU between January and June 2024 at our institution. Urinary symptoms were assessed at presentation and three months after treatment, including frequency, dysuria, urgency, nocturia, incontinence, incomplete emptying, weak stream, and straining. Symptom severity was measured using the International Prostate Symptom Score (IPSS). Statistical analysis was performed using SPSS version 26.0.

Results: Most patients were male (n=15; 75%) and aged 16–21 yr (n=11; 55%). Regular ketamine use was reported by 14 patients (70%), and 15 (75%) had used ketamine for over six years. At presentation, all patients reported urinary frequency and dysuria (100%), and 17 reported urgency (85%). After treatment, significant improvement was observed in dysuria (100% vs 75%; p=0.016), urgency (85% vs 40%; p=0.003), urinary incontinence (35% vs 10%; p=0.047), and incomplete emptying (30% vs 5%; p=0.037). IPSS scores shifted from severe to mild symptoms, although this change was not statistically significant (p=0.546).

Conclusions: KIU is associated with a high burden of urinary symptoms in young users. Recognition and targeted treatment can significantly improve key urinary outcomes. Patient summary: Young ketamine users frequently develop bladder symptoms. Symptoms improved following treatment, suggesting intervention may improve quality of life.

Keywords: Ketamine; Uropathy; Urinary Symptoms.

Highlights

• Ketamine-induced uropathy is associated with a significant burden of lower urinary tract symptoms in a predominantly young patient population.

• Urinary frequency, dysuria, and urgency were the most common presenting symptoms, with frequency and dysuria reported in all patients.

• Targeted treatment resulted in statistically significant improvement in dysuria, urgency, urinary incontinence, and incomplete bladder emptying at three months.

• Despite treatment, a proportion of patients continued to experience persistent symptoms, highlighting the chronic nature of the condition.

• These findings emphasise the importance of early recognition and structured management in patients with ketamine-induced uropathy.

Background: There are over one million dialysis patients in China, 80% of whom receive maintenance hemodialysis. Long-term dialysis increases the risk of oral frailty. This study reviews its influencing factors to provide evidence for early prevention and control.

Objective: This study conducted a systematic review of the factors associated with the occurrence of oral frailty in maintenance hemodialysis (MHD) patients based on relevant literature, to provide a reference for the clinical prevention of oral frailty in this population.

Methods: Computerized searches were performed in CNKI, WanFang Data, VIP Database, CBM, PubMed, Web of Science, Embase, and Cochrane Library from the establishment of each database to February 9, 2026. Quality assessment and analysis were conducted on the included literature.

Results: A total of 7 studies involving 1450 participants were finally included. The results of the meta-analysis showed that advanced age, sarcopenia, and malnutrition were risk factors for oral frailty in MHD patients, while higher grip strength and higher educational level were protective factors.

Conclusion: The factors influencing the occurrence of oral frailty in MHD patients are diverse and complex. In clinical practice, nursing staff should pay attention to the oral health of patients, identify the influencing factors, and implement interventions as early as possible. In the future, a risk prediction model for oral frailty in MHD patients should be constructed and validated to provide further evidence in support of relevant clinical interventions.